Cooperative composite video streams layered onto the surgical site and instruments

ABSTRACT

A computing system may generate a composite video stream from multiple input feeds. The computing system may obtain a surgical video stream and overlay content associated with a surgical procedure. The computing system may determine the overlay region location for overlaying the overlay content by analyzing the content of surgical video stream. For example, based on the content of a frame of the surgical video stream, the computing system may determine an overlay region location in the frame for overlaying the overlay content; based on the content of a subsequent frame of the surgical video stream, the computing system may determine another overlay region location in the subsequent frame for overlaying the overlay content. The composite video stream may be generated based on the overlay region locations determined for different frames of the surgical video stream.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of Provisional U.S. PatentApplication No. 63/224,813, filed Jul. 22, 2021, the disclosure of whichis incorporated herein by reference in its entirety.

This application is related to the following, filed contemporaneously,the contents of each of which are incorporated by reference herein:

-   -   U.S. patent application Ser. No. 17/384,274, filed Jul. 23,        2021, (Attorney Docket No. END9340USNP1), titled METHOD OF        SURGICAL SYSTEM POWER MANAGEMENT, COMMUNICATION, PROCESSING,        STORAGE AND DISPLAY    -   U.S. patent application Ser. No. 17/384,265, filed Jul. 23,        2021, (Attorney Docket No. END9340USNP12), titled REDUNDANT        COMMUNICATION CHANNELS AND PROCESSING OF IMAGING FEEDS

BACKGROUND

Surgical procedures are typically performed hi surgical operatingtheaters or rooms in a healthcare facility such as, for example, ahospital. Various surgical devices and systems are utilized inperformance of a surgical procedure. In the digital and information age,medical systems and facilities are often slower to implement systems orprocedures utilizing newer and improved technologies due to patientsafety and a general desire for maintaining traditional practices. It isdesirable to improve the delivery and processing of surgical videofeeds, such as an intraoperative video feed captured by a laparoscopicscope.

SUMMARY

A computing system may use redundant communication pathways forcommunicating surgical imaging feed(s). The computing system may obtainmultiple surgical video streams via multiple pathways. The multiplesurgical video streams may include different video feeds and/or copiesof the same video feed. The surgical video streams may be obtained, forexample, from the same intra-body imaging feed, such as an intra-bodyvisual light feed. For example, a first video stream may be obtained viaa communication pathway, and a second video stream may be obtained viaanother communication pathway. The computing system may display or senda surgical video stream for display. The computing system may determinewhether the video stream being displayed has encountered any issues.Upon detecting an issue with the video stream being displayed, thecomputing system may display another obtained surgical video stream orsend another obtained surgical video stream for display. For example, aprimary video stream may be displayed initially. Upon detecting an issueassociated with the primary video, a secondary video stream may bedisplayed.

In examples, the computing system may use redundant processing paths forprocessing surgical imaging feed(s). The computing system may obtain asource surgical imaging stream and may process the source imaging streamusing multiple processing modules. For example, at least some processingmodules may process the surgical imaging stream in parallel. Thecomputing system may determine whether any issues have been encounteredat the processing modules. If no issue has been found, the processedsurgical imaging streams may be merged for display. Upon detecting anissue associated with a processing module, the computing system mayselect a surgical imaging stream unaffected by the detected issue fordisplay. For example, a surgical imaging stream that has not beenprocessed by the processing module associated with the detected issuemay be selected for display.

A computing system may generate a composite video stream from multipleinput feeds. The computing system may obtain a surgical video stream andoverlay content associated with a surgical procedure onto the surgicalvideo stream. For example, the overlay content may be obtained from asecondary video feed or a portion of a secondary video feed. Thecomputing system may determine the overlay region location, size and/ororientation for overlaying the overlay content by analyzing the contentof surgical video stream. For example, based on the content of a frameof the surgical video stream, the computing system may determine anoverlay region location in the frame for overlaying the overlay content.Based on the content of a subsequent frame of the surgical video stream,the computing system may determine another overlay region location inthe subsequent frame for overlaying the overlay content. The compositevideo stream may be generated based on the overlay region locationsdetermined for different frames of the surgical video stream.

The computing system may determine the overlay region location, sizeand/or orientation for overlaying the overlay content based on one ormore fiducial marker(s) captured in the surgical video stream. Forexample, the computing system may identify the fiducial marker in thevideo frames of the surgical video stream and determine the respectivelocation, size, and/or orientation of the fiducial marker(s) inrespective video frames. For a given video frame, or a group of videoframes, the computing system may determine the size, location and/ororientation of the overlay region based on the location, size and/ororientation of the fiducial marker captured therein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a block diagram of a computer-implemented surgical system.

FIG. 1B is a block diagram of a computer-implemented multi-tier surgicalsystem.

FIG. 1C is a logical diagram illustrating control plane and data planeof a surgical system.

FIG. 2 shows an example surgical system in a surgical operating room.

FIG. 3 illustrates an example surgical hub paired with various systems.

FIG. 4 illustrates a surgical data network having a set of communicationsurgical hubs configured to connect with a set of sensing systems, anenvironmental sensing system, a set of devices, etc.

FIG. 5 illustrates an example computer-implemented interactive surgicalsystem that may be part of a surgical system.

FIG. 6 illustrates a logic diagram of a control system of a surgicalinstrument.

FIG. 7 shows an example surgical system that includes a handle having acontroller and a motor, an adapter releasably coupled to the handle, anda loading unit releasably coupled to the adapter.

FIG. 8 shows an example situationally aware surgical system.

FIGS. 9A-9C show an example visualization system.

FIG. 10 illustrates example instrumentation for near infraredspectroscopy (NIRS) spectroscopy.

FIG. 11 illustrates example instrumentation for determining NIRS basedon Fourier transform infrared imaging.

FIG. 12 illustrates example instrumentation that may be used to detect aDoppler shift in laser light scattered from portions of a tissue.

FIG. 13 illustrates an example composite image comprising a surfaceimage and an image of a subsurface blood vessel.

FIG. 14 illustrates an example visualization system.

FIG. 15 illustrates an example visualization system.

FIG. 16 illustrates an example process for using redundant pipe ways forcommunicating surgical imaging feed(s).

FIG. 17 illustrates an example process for using redundant processingpaths for communicating surgical imaging feed(s).

FIG. 18A illustrates an example process for generating a compositesurgical video stream from multiple input feeds.

FIG. 18B shows an example process for generating a composite surgicalvideo stream using a fiducial marker.

FIGS. 19A-19C illustrate example frames of a composite surgical videostream with overlay content that moves as a surgical instrument in thesurgical video stream moves.

DETAILED DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications, each of which is herein incorporated by reference in itsentirety:

-   -   U.S. patent application Ser. No. 15/940,654 (Attorney Docket No.        END8501USNP), entitled SURGICAL HUB SITUATIONAL AWARENESS, filed        Mar. 29, 2018;    -   U.S. patent application Ser. No. 15/940,742 (Attorney Docket No.        END8504USNP2), entitled DUAL CMOS ARRAY IMAGING, filed Mar. 29,        2018;    -   U.S. patent application Ser. No. 17/062,521 (Attorney Docket No.        END9287USNP2), entitled TIERED-ACCESS SURGICAL VISUALIZATION        SYSTEM, filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,530 (Attorney Docket No.        END9287USNP13), entitled SURGICAL HUB HAVING VARIABLE        INTERCONNECTIVITY CAPABILITIES, filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,512 (Attorney Docket No.        END9287USNP14), entitled TIERED SYSTEM DISPLAY CONTROL BASED ON        CAPACITY AND USER OPERATION, filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,508 (Attorney Docket No.        END9287USNP15), entitled COOPERATIVE SURGICAL DISPLAYS, filed        Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,509 (Attorney Docket No.        END9287USNP16, entitled INTERACTIVE INFORMATION OVERLAY ON        MULTIPLE SURGICAL DISPLAYS, filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,507 (Attorney Docket No.        END9287USNP17, entitled COMMUNICATION CONTROL FOR A SURGEON        CONTROLLED SECONDARY DISPLAY AND PRIMARY DISPLAY, filed Oct. 2,        2020;    -   U.S. patent application Ser. No. 17/062,513 (Attorney Docket No.        END9288USNP1, entitled SITUATIONAL AWARENESS OF INSTRUMENTS        LOCATION AND INDIVIDUALIZATION OF USERS TO CONTROL DISPLAYS,        filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,517 (Attorney Docket No.        END9288USNP2, entitled SHARED SITUATIONAL AWARENESS OF THE        DEVICE ACTUATOR ACTIVITY TO PRIORITIZE CERTAIN ASPECTS OF        DISPLAYED INFORMATION, filed Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,520 (Attorney Docket No.        END9288USNP3, entitled MONITORING OF USER VISUAL GAZE TO CONTROL        WHICH DISPLAY SYSTEM DISPLAYS THE PRIMARY INFORMATION, filed        Oct. 2, 2020;    -   U.S. patent application Ser. No. 17/062,519 (Attorney Docket No.        END9288USNP4, entitled RECONFIGURATION OF DISPLAY SHARING, filed        Oct. 2, 2020; and    -   U.S. patent application Ser. No. 17/062,516 (Attorney Docket No.        END9288USNP5, entitled CONTROL OF A DISPLAY OUTSIDE THE STERILE        FIELD FROM A DEVICE WITHIN THE STERILE FIELD, filed Oct. 2,        2020.

FIG. 1A is a block diagram of a computer-implemented surgical system20000. An example surgical system such as the surgical system 20000 mayinclude one or more surgical systems (e.g., surgical sub-systems) 20002,20003 and 20004. For example, surgical system 20002 may include acomputer-implemented interactive surgical system. For example, surgicalsystem 20002 may include a surgical hub 20006 and/or a computing device20016 in communication with a cloud computing system 20008, for example,as described in FIG. 2 . The cloud computing system 20008 may include atleast one remote cloud server 20009 and at least one remote cloudstorage unit 20010. Example surgical systems 20002, 20003, or 20004 mayinclude a wearable sensing system 20011, an environmental sensing system20015, a robotic system 20013, one or more intelligent instruments20014, human interface system 20012, etc. The human interface system isalso referred herein as the human interface device. The wearable sensingsystem 20011 may include one or more HCP sensing systems, and/or one ormore patient sensing systems. The environmental sensing system 20015 mayinclude one or more devices, for example, used for measuring one or moreenvironmental attributes, for example, as further described in FIG. 2 .The robotic system 20013 may include a plurality of devices used forperforming a surgical procedure, for example, as further described inFIG. 2 .

The surgical system 20002 may be in communication with a remote server20009 that may be part of a cloud computing system 20008. In an example,the surgical system 20002 may be in communication with a remote server2000) via an internet service provider's cable/FIOS networking node. Inan example, a patient sensing system may be in direct communication witha remote server 20009. The surgical system 20002 and/or a componenttherein may communicate with the remote servers 20009 via a cellulartransmission/reception point (TRP) or a base station using one or moreof the following cellular protocols: GSM/GPRS/EDGE (2G), UMTS/HSPA (3G),long term evolution (LTE) or 4G, LTE-Advanced (LTE-A), new radio (NR) or5G.

A surgical hub 20006 may have cooperative interactions with one of moremeans of displaying the image from the laparoscopic scope andinformation from one or more other smart devices and one or more sensingsystems 20011. The surgical hub 20006 may interact with one or moresensing systems 20011, one or more smart devices, and multiple displays.The surgical hub 20006 may be configured to gather measurement data fromthe one or more sensing systems 20011 and send notifications or controlmessages to the one or more sensing systems 20011. The surgical hub20006 may send and/or receive information including notificationinformation to and/or from the human interface system 20012. The humaninterface system 20012 may include one or more human interface devices(HIDs). The surgical hub 20006 may send and/or receive notificationinformation or control information to audio, display and/or controlinformation to various devices that are in communication with thesurgical hub.

For example, the sensing systems 20001 may include the wearable sensingsystem 20011 (which may include one or more HCP sensing systems and oneor more patient sensing systems) and the environmental sensing system20015 as discussed in FIG. 1A. The one or more sensing systems 20001 maymeasure data relating to various biomarkers. The one or more sensingsystems 20001 may measure the biomarkers using one or more sensors, forexample, photosensors (e.g., photodiodes, photoresistors), mechanicalsensors (e.g., motion sensors), acoustic sensors, electrical sensors,electrochemical sensors, thermoelectric sensors, infrared sensors, etc.The one or more sensors may measure the biomarkers as described hereinusing one of more of the following sensing technologies:photoplethysmography, electrocardiography, electroencephalography,colorimetry, impedimentary, potentiometry, amperometry, etc.

The biomarkers measured by the one or more sensing systems 20001 mayinclude, but are not limited to, sleep, core body temperature, maximaloxygen consumption, physical activity, alcohol consumption, respirationrate, oxygen saturation, blood pressure, blood sugar, heart ratevariability, blood potential of hydrogen, hydration state, heart rate,skin conductance, peripheral temperature, tissue perfusion pressure,coughing and sneezing, gastrointestinal motility, gastrointestinal tractimaging, respiratory tract bacteria, edema, mental aspects, sweat,circulating tumor cells, autonomic tone, circadian rhythm, and/ormenstrual cycle.

The biomarkers may relate to physiologic systems, which may include, butare not limited to, behavior and psychology, cardiovascular system,renal system, skin system, nervous system, gastrointestinal system,respiratory system, endocrine system, immune system, tumor,musculoskeletal system, and/or reproductive system. Information from thebiomarkers may be determined and/or used by the computer-implementedpatient and the surgical system 20000, for example. The information fromthe biomarkers may be determined and/or used by the computer-implementedpatient and the surgical system 20000 to improve said systems and/or toimprove patient outcomes, for example. The one or more sensing systems20001, biomarkers 20005, and physiological systems are described in moredetail in U.S. application Ser. No. 17/156,287 (attorney docket numberEND9290USNP1), titled METHOD OF ADJUSTING A SURGICAL PARAMETER BASED ONBIOMARKER MEASUREMENTS, filed Jan. 22, 2021, the disclosure of which isherein incorporated by reference in its entirety.

FIG. 1B is a block diagram of a computer-implemented multi-tier surgicalsystem. As illustrated in FIG. 1B, a computer-implemented multi-tiersurgical system 40050 may include multiple tiers of systems, such as asurgical specific sub-network tier system 40052, an edge tier system40054 that is associated with the surgical specific sub-network tiersystem 40052, and a cloud tier system 40056.

A surgical specific sub-network tier system 40052 may include aplurality of inter-connected surgical sub-systems. For example, thesurgical sub-systems may be grouped by the type of surgical proceduresand/or other departments in a medical facility or a hospital. Forexample, a medical facility or a hospital may include a plurality ofsurgical procedure specific departments, such as an emergency room (FR)department 40070, colorectal department 40078, bariatric department40072, thoracic department 40066, and billing department 40068. Each ofthe surgical procedure specific departments may include one or moresurgical sub-systems associated with an operating room (OR) and/or ahealthcare care professional (HCP). For example, the colorectaldepartment 40078 may include a set of surgical hubs (e.g., surgical hub20006 as described in FIG. 1A). The surgical hubs may be designated fora respective HCP, such as HCP A, 40082 and HCP B, 40080. In an example,the colorectal department may include a group of surgical hubs that maybe located in respective ORs, such as OR 1, 40074 and OR 2, 40076. Themedical facility or the hospital may also include a billing departmentsubsystem 40068. The billing department subsystem 40068 may store and/ormanage billing data associated with a respective department, such as theER department 40070, colorectal department 40078, bariatric department40072, and/or thoracic department 40066.

An edge tier system 40054 may be associated with a medical facility or ahospital and may include one or more edge computing systems 40064, forexample. An edge computing system 40064 may include a storage sub-systemand a server sub-system. In an example, the edge computing systemcomprising an edge server and/or a storage unit may provide additionalprocessing and/or storage services to a surgical hub that is part of oneof the departmental ORs (e.g., OR1 and OR2 of the colorectaldepartment).

The surgical specific sub-network tier system 40052 and the edge tiersystem 40054 may be located within a Health Insurance Portability andAccountability Act (HIPAA) boundary 40062. The surgical specificsub-network system 40052 and the edge tier system 40054 may be connectedto the same local data network. The local data network may be a localdata network of a medical facility or a hospital. The local data networkmay be within the HIPAA boundary. Because the surgical specificsub-network tier system 40052 and the edge tier system 40054 are locatedwithin the HIPAA boundary 40062, patient data between an edge computingsystem 40064 and a device located within one of the entities of thesurgical specific sub-network tier system 40052 may flow withoutredaction and/or encryption. For example, patient data between an edgecomputing system 40064 and a surgical hub located in OR1 40074 of thecolorectal department 40078 may flow without redaction and/orencryption.

The cloud tier system 40056 may include an enterprise cloud system 40060and a public cloud system 40058. For example, the enterprise cloudsystem 40060 may be a cloud computing system 20008 that includes aremote cloud server sub-system and/or a remote cloud storage subsystem,as described in FIG. 1A. The enterprise cloud system 40060 may bemanaged by an organization, such as a private company. The enterprisecloud system 40060 may be in communication with one or more entities(e.g., edge computing systems 40064, surgical hubs located in ORs (e.g.,OR1 40074) of the various departments (e.g., colorectal department40078)) that are located within the HIPAA boundary 40062.

The public cloud system 40058 may be operated by a cloud computingservice provider. For example, the cloud computing service provider mayprovide storage services and/or computing services to a plurality ofenterprise cloud systems (e.g., enterprise cloud system 40060).

FIG. 1C is a logical block diagram 40000 illustrating variouscommunication planes in a surgical system. As illustrated in FIG. 1C,the communication planes between a controller 40002 and managementapplications 40014 and 40016 on one side and, the system modules and/ormodular devices 40012 a through 40012 n on the other side, may usecontrol plane 40008 and data plane 40010. In an example, in addition tothe control plane 40008, a data plane may also exist between the systemmodules and/or modular devices 40012 a through 40012 n and the surgicalhub. The data plane 40010 may provide data plane paths (e.g., redundantdata plane paths) between the system modules and/or the modular devices40012 a through 40012 n that are associated with one or more surgicalhubs. A surgical hub or one of the surgical hubs (e.g., in case of aplurality of surgical hubs present in an operating room) may act as acontroller 40002. In an example, the controller 40002 may be an edgecomputing system that may reside within a Health Insurance Portabilityand Accountability Act (HIPAA) boundary where the surgical system islocated, for example, as illustrated in FIG. 1B. The controller 40002may be in communication with an enterprise cloud system 40020. Asillustrated in FIG. 1C, the enterprise cloud system 40020 may be locatedoutside the HIPAA boundary 40018. Accordingly, the patient data flowingto and/or from the enterprise cloud system 40020 may be redacted and/orencrypted.

The controller 40002 may be configured to provide a northbound interface40004 and a southbound interface 40006. The northbound interface 40004may be used for providing a control plane 400108. The control plane40008 may include one or more management applications 40014 and 40016that may enable a user to configure and/or manage system modules and/ormodular devices modular devices 40012 a through 40012 n associated witha surgical system. The management applications 40014 and 40016 may beused to obtain status of various system modules and/or the modulardevices 40012 a through 40012 n.

The management applications 40014 and 40016 using the control plane mayinteract with the controller 40002, for example, using a set ofapplication programming interface (API) calls. The managementapplications 40014 and 40016 may interact with the controller 40002 viaa management protocol or an application layer protocol to configureand/or monitor the status of a system module and/or a modular device.The management protocols or the application layer protocols used tomonitor the status and/or configure a system module or a modular deviceassociated with a surgical system may include the simple networkmanagement protocol (SNMP), TELNET protocol, secure shell (SSH)protocol, network configuration protocol (NETCONF), etc.

SNMP or a similar protocol may be used to collect status informationand/or send configuration related data (e.g., configuration relatedcontrol programs) associated with system modules and/or modular devicesto the controller. SNMP or a similar protocol may collect information byselecting devices associated with a surgical system from a centralnetwork management console using messages (e.g., SNMP messages). Themessages may be sent and/or received at fixed or random intervals. Themessages may include Get messages and Set messages. The Get messages ormessages similar to the Get messages may be used for obtaininginformation from a system module or a modular device associated with asurgical system. The Set message or messages similar to the Set messagemay be used for changing a configuration associated with a system moduleor a modular device associated with a surgical system.

For example, the Get messages or similar messages may include the SNMPmessages GetRequest, GetNextRequest, or GetBulkRequest. The Set messagesmay include SNMP SetRequest message. The GetRequest, GetNextRequest,GetBulkRequest messages or similar messages may be used by aconfiguration manager (e.g., an SNMP manager) running on the controller40002. The configuration manager may be in communication with acommunication agent (e.g., an SNMP agent) that may be a part of a systemmodule and/or a modular device in a surgical system. The SNMP messageSetRequest message or similar may be used by the communication manageron the controller 40002 to set the value of a parameter or an objectinstance in the communication agent on a system module and/or a modulardevice of a surgical system. In an example, SNMP modules, for example,may be used to establish communication path between system modulesand/or modular devices associated with a surgical system.

Based on the query or configuration related messages received from amanagement application, such as management applications 40014 and 40016,the controller 40002 may generate configuration queries and/orconfiguration data for querying or configuring the system modules and/orthe modular devices associated with the surgical hub or the surgicalsystem. A surgical hub (e.g., the surgical hub 20006 shown in FIG. 1A)or an edge computing system (e.g., the edge computing system 40064 shownin FIG. 1B) may manage and/or control various system modules and/ormodular devices 40012 a through 40012 n associated with a surgicalsystem. For example, the northbound interface 40004 of the controller40002 may be used for changing control interactions between one or moremodules associated and/or devices associated with a surgical system. Inan example, the controller 40102 may be used for establishing one ormore communication data paths between a plurality of modules and/ordevices associated with a surgical system. The controller 40002 may useits southbound interface 40006 to send the control programs comprisingqueries and/or configuration changes to the system modules and/or themodular devices of the surgical system.

The system modules and/or the modular devices 40012 a through 40012 n ofa surgical system, or the communication agents that may be a part of thesystem modules and/or the modular devices, may send notificationmessages or traps to the controller 40002. The controller may forwardthe notification messages or traps via its northbound interface 40004 tothe management application 40014 and 40016 for displaying on a display.In an example, the controller 40002 may send the notification to othersystem modules and/or modular devices 40012 a through 40012 n that arepart of the surgical system.

The system modules and/or the modular devices 40012 a through 40012 n ofa surgical system or the communication agents that are part of thesystem modules and/or the modular devices may send responses to thequeries received from the controller 40002. For example, a communicationagent that may be part of a system module or a modular device may send aresponse message in response to a Get or a Set message or messagessimilar to the Get or the Set messages received from the controller40002. In an example, in response to a Get message or a similar messagereceived from the controller 40002, the response message from the systemmodule or the modular device 40012 a through 40012 n may include thedata requested. In an example, in response to a Set message or a similarmessage received from a system module or a modular device 40012 athrough 40012 n, the response message from the controller 40002 mayinclude the newly set value as confirmation that the value has been set.

A trap or a notification message or a message similar to the trap or thenotification message may be used by a system module or a modular device40012 a through 40012 n to provide information about events associatedwith the system modules or the modular devices. For example, a trap or anotification message may be sent from a system module or a modulardevice 40012 a through 40012 n to the controller 40002 indicating astatus of a communication interface (e.g., whether it available orunavailable for communication). The controller 40002 may send a receiptof the trap message back to the system module or the modular device40012 a through 40012 n (e.g., to the agent on the system module or amodular device).

In an example, TELNET protocol may be used to provide a bidirectionalinteractive text-oriented communication facility between system modulesand/or modular devices 40012 a through 40012 n and the controller 40002.TELNET protocol may be used to collect status information and/or sendconfiguration data (e.g., control programs) from/to the controller40002. TELNET may be used by one of the management applications 40014 or40016 to establish a connection with the controller 40002 using thetransmission control protocol port number 23.

In an example, SSH, a cryptographic encrypted protocol, may be used toallow remote login and to collect status information and/or sendconfiguration data about system modules and/or modular devices 40012 athrough 40012 n from/to the controller 40002. SSH may be used by one ofthe management applications 40014 or 40016 to establish an encryptedconnection with the controller 40002 using the transmission controlprotocol port number 22.

In an example, NETCONF may be used to perform management functions byinvoking remote procedure calls using, for example, <rpc>, <rpc-reply>,or <edit-config> operations. The <rpc> and <rpc-reply> procedure callsor similar procedure calls may be used for exchanging information from asystem module and/or a modular device associated with a surgical system.The NETCONF <edit-config> operation or a similar operation may be usedfor configuring the system modules and/or the modular devices associatedwith the surgical system.

The controller 40002 may configure the system modules and/or modulardevice 40012 a through 40012 n to establish a data plane 40010. The dataplane 40010 (e.g., also referred to as a user plane or a forwardingplane) may enable a communication data path between a plurality ofsystem modules and/or modular device 40012 a through 40012 n. The dataplane 40010 may be utilized by the system modules and/or the modulardevice 40012 a through 40012 n for communicating data flows of databetween the system modules and/or modular devices associated with asurgical system. The data flows may be established using one or morededicated communication interfaces between the system modules and/or themodular devices associated with one or more surgical hubs of a surgicalsystem. In an example, the data flows may be established over one ormore local area networks (LANs) and one or more wide area networks(WANs), such as the Internet.

In an example, the data plane 40010 may provide support for establishinga first and a second independent, disjointed, concurrent, and redundantcommunication path for data flow between the system modules and/ormodular devices 40012 b and 40012 n. As illustrated in FIG. 1C.redundant communication paths may be established between systemmodules/modular devices 40012 b and 40012 n. The redundant communicationpaths may carry same/redundant data flows between the system modulesand/or modular devices. In an example, when or if some of the datapackets are dropped on one of the redundant communication paths due toproblems with one of the communication interfaces on the systemmodules/modular devices 40012 b and 40012 n, the system modules and/orthe modular devices may continue to send/receive at least one copy ofthe dropped data packets over the second communication path.

FIG. 2 shows an example of a surgical system 20002 in a surgicaloperating room. As illustrated in FIG. 2 , a patient is being operatedon by one or more health care professionals (HCPs). The HCPs are beingmonitored by one or more HCP sensing systems 20020 worn by the HCPs. TheHCPs and the environment surrounding the HCPs may also be monitored byone or more environmental sensing systems including, for example, a setof cameras 20021, a set of microphones 20022, and other sensors that maybe deployed in the operating room. The HCP sensing systems 20020 and theenvironmental sensing systems may be in communication with a surgicalhub 20006, which in turn may be m communication with one or more cloudservers 20009 of the cloud computing system 20008, as shown in FIG. 1A.The environmental sensing systems may be used for measuring one or moreenvironmental attributes, for example, HCP position in the surgicaltheater, HCP movements, ambient noise in the surgical theater,temperature/humidity in the surgical theater, etc.

As illustrated in FIG. 2 , a primary display 20023 and one or more audiooutput devices (e.g., speakers 20019) are positioned in the sterilefield to be visible to an operator at the operating table 20024. Inaddition, a visualization/notification tower 20026 is positioned outsidethe sterile field. The visualization/notification tower 20026 mayinclude a first non-sterile human interactive device (HID) 20027 and asecond non-sterile HID 20029, which may face away from each other. TheHID may be a display or a display with a touchscreen allowing a human tointerface directly with the HID. A human interface system, guided by thesurgical hub 20006, may be configured to utilize the HIDs 20027, 20029,and 20023 to coordinate information flow to operators inside and outsidethe sterile field. In an example, the surgical hub 20006 may cause anHID (e.g., the primary HID 20023) to display a notification and/orinformation about the patient and/or a surgical procedure step. In anexample, the surgical hub 20006 may prompt for and/or receive input frompersonnel in the sterile field or in the non-sterile area. In anexample, the surgical hub 20006 may cause an HID to display a snapshotof a surgical site, as recorded by an imaging device 20030, on anon-sterile HID 20027 or 20029, while maintaining a live feed of thesurgical site on the primary HID 20023. The snapshot on the non-steriledisplay 20027 or 20029 can permit a non-sterile operator to perform adiagnostic step relevant to the surgical procedure, for example.

In one aspect, the surgical hub 20006 may be configured to mute adiagnostic input or feedback entered by a non-sterile operator at thevisualization tower 20026 to the primary display 20023 within thesterile field, where it can be viewed by a sterile operator at theoperating table. In one example, the input can be in the form of amodification to the snapshot displayed on the non-sterile display 20027or 20029, which can be routed to the primary display 20023 by thesurgical hub 20006.

Referring to FIG. 2 , a surgical instrument 20031 is being used in thesurgical procedure as part of the surgical system 20002. The hub 20006may be con figured to coordinate information flow to a display of thesurgical instrument 20031. For example, in U.S. Patent ApplicationPublication No. US 2019-0200844 A1 (U.S. patent application Ser. No.16/209,385), tided METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE ANDDISPLAY, filed Dec. 4, 2018, the disclosure of which is hereinincorporated by reference in its entirety. A diagnostic input orfeedback entered by a non-sterile operator at the visualization tower20026 can be routed by the hub 20006 to the surgical instrument displaywithin the sterile field, where it can be viewed by the operator of thesurgical instrument 20031. Example surgical instruments that aresuitable for use with the surgical system 20002 are described under theheading “Surgical Instrument Hardware” and in U.S. Patent ApplicationPublication No. US 2019-0200844 A1 (U.S. patent application Ser. No.16/209,385), titled METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE ANDDISPLAY, filed Dec. 4, 2018, the disclosure of which is hereinincorporated by reference in its entirety, for example.

FIG. 2 illustrates an example of a surgical system 20002 being used toperform a surgical procedure on a patient who is lying down on anoperating table 20024 in a surgical operating room 20035. A roboticsystem 20034 may be used in the surgical procedure as a part of thesurgical system 20002. The robotic system 20034 may include a surgeon'sconsole 20036, a patient side cart 20032 (surgical robot), and asurgical robotic hub 20033. The patient side cart 20032 can manipulateat least one removably coupled surgical tool 20037 through a minimallyinvasive incision in the body of the patient while the surgeon views thesurgical site through the surgeon's console 20036. An image of thesurgical site can be obtained by a medical imaging device 20030, whichcan be manipulated by the patient side cart 20032 to orient the imagingdevice 20030. The robotic hub 20033 can be used to process the images ofthe surgical site for subsequent display to the surgeon through thesurgeon's console 20036.

Other types of robotic systems can be readily adapted for use with thesurgical system 20002. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Patent Application Publication No. US 2019-0201137 A1(U.S. patent application Ser. No. 16/209,407), tided METHOD OF ROBOTICHUB COMMUNICATION, DETECTION, AND CONTROL, filed Dec. 4, 2018, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud computing system 20008, and are suitable for use with the presentdisclosure, are described in U.S. Patent Application Publication No. US2019-0206569 A1 (U.S. patent application Ser. No. 16/209,403), titledMETHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB, filed Dec. 4,2018, the disclosure of which is herein incorporated by reference in itsentirety.

In various aspects, the imaging device 20030 may include at least oneimage sensor and one or more optical components. Suitable image sensorsmay include, but are not limited to, Charge-Coupled Device (CCD) sensorsand Complementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 20030 may include one ormore illumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is the portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that range from about 380 nm to about750 nm.

The invisible spectrum (e.g., the non-luminous spectrum) is the portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 20030 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but are not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

The imaging device may employ multi-spectrum monitoring to discriminatetopography and underlying structures. A multi-spectral image is one thatcaptures image data within specific wavelength ranges across theelectromagnetic spectrum. The wavelengths may be separated by filters orby the use of instruments that are sensitive to particular wavelengths,including light from frequencies beyond the visible light range, e.g.,IR and ultraviolet. Spectral imaging can allow extraction of additionalinformation that the human eye fails to capture with its receptors forred, green, and blue. The use of multi-spectral imaging is described ingreater detail under the heading “Advanced Imaging Acquisition Module”in U.S. Patent Application Publication No. US 2019-0200844 A1 (U.S.patent application Ser. No. 16/209,385), titled METHOD OF HUBCOMMUNICATION, PROCESSING, STORAGE AND DISPLAY, filed Dec. 4, 2018, thedisclosure of which is herein incorporated by reference in its entirety.Multi-spectrum monitoring can be a useful tool in relocating a surgicalfield after a surgical task is completed to perform one or more of thepreviously described tests on the treated tissue. It is axiomatic thatstrict sterilization of the operating room and surgical equipment isrequired during any surgery. The strict hygiene and sterilizationconditions required in a “surgical theater,” i.e., an operating ortreatment room, necessitate the highest possible sterility of allmedical devices and equipment. Part of that sterilization process is theneed to sterilize anything that comes in contact with the patient orpenetrates the sterile field, including the imaging device 20030 and itsattachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area.

Wearable sensing system 20011 illustrated in FIG. 1A may include one ormore sensing systems, for example, HCP sensing systems 20020 as shown inFIG. 2 . The HCP sensing systems 20020 may include sensing systems tomonitor and detect a set of physical states and/or a set ofphysiological states of a healthcare personnel (HCP). An HCP may be asurgeon or one or more healthcare personnel assisting the surgeon orother healthcare service providers in general. In an example, a sensingsystem 20020 may measure a set of biomarkers to monitor the heart rateof an HCP. In an example, a sensing system 20020 worn on a surgeon'swrist (e.g., a watch or a wristband) may use an accelerometer to detecthand motion and/or shakes and determine the magnitude and frequency oftremors. The sensing system 20020 may send the measurement dataassociated with the set of biomarkers and the data associated with aphysical state of the surgeon to the surgical hub 20006 for furtherprocessing. One or more environmental sensing devices may sendenvironmental information to the surgical hub 20006. For example, theenvironmental sensing devices may include a camera 20021 for detectinghand/body position of an HCP. The environmental sensing devices mayinclude microphones 20022 for measuring the ambient noise in thesurgical theater. Other environmental sensing devices may includedevices, for example, a thermometer to measure temperature and ahygrometer to measure humidity of the surroundings in the surgicaltheater, etc. The surgical hub 20006, alone or in communication with thecloud computing system, may use the surgeon biomarker measurement dataand/or environmental sensing information to modify the controlalgorithms of hand-held instruments or the averaging delay of a roboticinterface, for example, to minimize tremors. In an example, the HCPsensing systems 20020 may measure one or more surgeon biomarkersassociated with an HCP and send the measurement data associated with thesurgeon biomarkers to the surgical hub 20006. The HCP sensing systems20020 may use one or more of the following RF protocols forcommunicating with the surgical hub 20006: Bluetooth, BluetoothLow-Energy (BLE), Bluetooth Smart, Zigbee, Z-wave, IPv6 Low-powerwireless Personal Area Network (6LoWPAN), Wi-Fi. The surgeon biomarkersmay include one or more of the following: stress, heart rate, etc. Theenvironmental measurements from the surgical theater may include ambientnoise level associated with the surgeon or the patient, surgeon and/orstaff movements, surgeon and/or staff attention level, etc.

The surgical hub 20006 may use the surgeon biomarker measurement dataassociated with an HCP to adaptively control one or more surgicalinstruments 20031. For example, the surgical hub 20006 may send acontrol program to a surgical instrument 20031 to control its actuatorsto limit or compensate for fatigue and use of fine motor skills. Thesurgical hub 20006 may send the control program based on situationalawareness and/or the context on importance or criticality of a task. Thecontrol program may instruct the instrument to alter operation toprovide more control when control is needed.

FIG. 3 shows an example surgical system 20002 with a surgical hub 20006paired with a wearable sensing system 20011, an environmental sensingsystem 20015, a human interface system 20012, a robotic system 20013,and an intelligent instrument 20014. The hub 20006 includes a display20048, an imaging module 20049, a generator module 20050, acommunication module 20056, a processor module 20057, a storage array20058, and an operating-room mapping module 20059. In certain aspects,as illustrated in FIG. 3 , the hub 20006 further includes a smokeevacuation module 20054 and/or a suction/irrigation module 20055. Duringa surgical procedure, energy application to tissue, for sealing and/orcutting, is generally associated with smoke evacuation, suction ofexcess fluid, and/or irrigation of the tissue. Fluid, power, and/or datalines from different sources are often entangled during the surgicalprocedure. Valuable time can be lost addressing this issue during asurgical procedure. Detangling the lines may necessitate disconnectingthe lines from their respective modules, which may require resetting themodules. The hub modular enclosure 20060 offers a unified environmentfor managing the power, data, and fluid lines, which reduces thefrequency of entanglement between such lines. Aspects of the presentdisclosure present a surgical hub 20006 for use in a surgical procedurethat involves energy application to tissue at a surgical site. Thesurgical hub 20006 includes a hub enclosure 20060 and a combo generatormodule slidably receivable in a docking station of the hub enclosure20060. The docking station includes data and power contacts. The combogenerator module includes two or more of an ultrasonic energy generatorcomponent, a bipolar RF energy generator component, and a monopolar RFenergy generator component that are housed in a single unit. In oneaspect, the combo generator module also includes a smoke evacuationcomponent, at least one energy delivery cable for connecting the combogenerator module to a surgical instrument, at least one smoke evacuationcomponent configured to evacuate smoke, fluid, and/or particulatesgenerated by the application of therapeutic energy to the tissue, and afluid line extending from the remote surgical site to the smokeevacuation component. In one aspect, the fluid line may be a first fluidline, and a second fluid line may extend from the remote surgical siteto a suction and irrigation module 20055 slidably received in the hubenclosure 20060. In one aspect, the hub enclosure 20060 may include afluid interface. Certain surgical procedures may require the applicationof more than one energy type to the tissue. One energy type may be morebeneficial for cutting the tissue, while another different energy typemay be more beneficial for sealing the tissue. For example, a bipolargenerator can be used to seal the tissue while an ultrasonic generatorcan be used to cut the sealed tissue. Aspects of the present disclosurepresent a solution where a hub modular enclosure 20060 is configured toaccommodate different generators and facilitate an interactivecommunication therebetween. One of the advantages of the hub modularenclosure 20060 is enabling the quick removal and/or replacement ofvarious modules. Aspects of the present disclosure present a modularsurgical enclosure for use in a surgical procedure that involves energyapplication to tissue. The modular surgical enclosure includes a firstenergy-generator module, configured to generate a first energy forapplication to the tissue, and a first docking station comprising afirst docking port that includes first data and power contacts, whereinthe first energy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts. Further to the above,the modular surgical enclosure also includes a second energy-generatormodule configured to generate a second energy, different than the firstenergy, for application to the tissue, and a second docking stationcomprising a second docking port that includes second data and powercontacts, wherein the second energy generator module is slidably movableinto an electrical engagement with the power and data contacts, andwherein the second energy-generator module is slidably movable out ofthe electrical engagement with the second power and data contacts. Inaddition, the modular surgical enclosure also includes a communicationbus between the first docking port and the second docking port,configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.Referring to FIG. 3 , aspects of the present disclosure are presentedfor a hub modular enclosure 20060 that allows the modular integration ofa generator module 20050, a smoke evacuation module 20054, and asuction/irrigation module 20055. The hub modular enclosure 20060 furtherfacilitates interactive communication between the modules 20059, 20054,and 20055. The generator module 20050 can be with integrated monopolar,bipolar, and ultrasonic components supported in a single housing unitslidably insertable into the hub modular enclosure 20060. The generatormodule 20050 can be configured to connect to a monopolar device 20051, abipolar device 20052, and an ultrasonic device 20053. Alternatively, thegenerator module 20050 may comprise a series of monopolar, bipolar,and/or ultrasonic generator modules that interact through the hubmodular enclosure 20060. The hub modular enclosure 20060 can beconfigured to facilitate the insertion of multiple generators andinteractive communication between the generators docked into the hubmodular enclosure 20060 so that the generators would act as a singlegenerator.

FIG. 4 illustrates a surgical data network having a set of communicationhubs configured to connect a set of sensing systems, environment sensingsystem(s), and a set of other modular devices located in one or moreoperating theaters of a healthcare facility, a patient recovery room, ora mom in a healthcare facility specially equipped for surgicaloperations, to the cloud, in accordance with at least one aspect of thepresent disclosure.

As illustrated in FIG. 4 , a surgical hub system 20060 may include amodular communication hub 20065 that is configured to connect modulardevices located in a healthcare facility to a cloud-based system (e.g.,a cloud computing system 20064 that may include a remote server 20067coupled to a remote storage 20068). The modular communication hub 20065and the devices may be connected in a room in a healthcare facilityspecially equipped for surgical operations. In one aspect, the modularcommunication hub 20065 may include a network hub 20061 and/or a networkswitch 20062 in communication with a network router 20066. The modularcommunication hub 20065 may be coupled to a local computer system 20063to provide local computer processing and data manipulation.

The computer system 20063 may comprise a processor and a networkinterface 20100. The processor may be coupled to a communication module,storage, memory, non-volatile memory, and input/output (I/O) interfacevia a system bus. The system bus can be any of several types of busstructure(s) including the memory bus or memory controller, a peripheralbus or external bus, and/or a local bus using any variety of availablebus architectures including, but not limited to, 9-bit bus, IndustrialStandard Architecture (ISA), Micro-Charmel Architecture (MSA), ExtendedISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB),Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port(AGP), Personal Computer Memory Card International Association bus(PCMCIA), Small Computer Systems Interface (SCSI), or any otherproprietary bus.

The processor may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In an example, the processor may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x, known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

It is to be appreciated that the computer system 20063 may includesoftware that acts as an intermediary between users and the basiccomputer resources described in a suitable operating environment. Suchsoftware may include an operating system. The operating system, whichcan be stored on the disk storage, may act to control and allocateresources of the computer system. System applications may take advantageof the management of resources by the operating system through programmodules and program data stored either in the system memory or on thedisk storage. It is to be appreciated that various components describedherein can be implemented with various operating systems or combinationsof operating systems.

A user may enter commands or information into the computer system 20063through input device(s) coupled to the I/O interface. The input devicesmay include, but are not limited to, a pointing device such as a mouse,trackball, stylus, touch pad, keyboard, microphone, joystick, game pad,satellite dish, scanner, TV tuner card, digital camera, digital videocamera, web camera, and the like. These and other input devices connectto the processor 20102 through the system bus via interface port(s). Theinterface port(s) include, for example, a serial port, a parallel port,a game port, and a USB. The output device(s) use some of the same typesof ports as input device(s). Thus, for example, a USB port may be usedto provide input to the computer system 20063 and to output informationfrom the computer system 20063 to an output device. An output adaptermay be provided to illustrate that there can be some output devices likemonitors, displays, speakers, and printers, among other output devicesthat may require special adapters. The output adapters may include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), may provide both input and outputcapabilities.

The computer system 20063 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) may be logically connected to the computer systemthrough a network interface and then physically connected via acommunication connection. The network interface may encompasscommunication networks such as local area networks (LANs) and wide areanetworks (WANs). LAN technologies may include Fiber Distributed DataInterface (FDDI), Copper Distributed Data Interface (CDDI),Ethernet/IEEE 802.3, Token Ring/IEEE 802.5, and the like. WANtechnologies may include, but are not limited to, point-to-point links,circuit-switching networks like Integrated Services Digital Networks(ISDN) and variations thereon, packet-switching networks, and DigitalSubscriber Lines (DSL).

In various examples, the computer system 20063 may comprise an imageprocessor, image-processing engine, media processor, or any specializeddigital signal processor (DSP) used for the processing of digitalimages. The image processor may employ parallel computing with singleinstruction, multiple data (SIMD) or multiple instruction, multiple data(MIMD) technologies to increase speed and efficiency. The digitalimage-processing engine can perform a range of tasks. The imageprocessor may be a system on a chip with multicore processorarchitecture.

The communication connection(s) may refer to the hardware/softwareemployed to connect the network interface to the bus. While thecommunication connection is shown for illustrative clarity inside thecomputer system 20063, it can also be external to the computer system20063. The hardware/software necessary for connection to the networkinterface may include, for illustrative purposes only, internal andexternal technologies such as modems, including regular telephone-grademodems, cable modems, optical fiber modems, and DSL modems, ISDNadapters, and Ethernet cards. In some examples, the network interfacemay also be provided using an RF interface.

Surgical data network associated with the surgical hub system 20060 maybe configured as passive, intelligent, or switching. A passive surgicaldata network serves as a conduit for the data, enabling it to go fromone device (or segment) to another and to the cloud computing resources.An intelligent surgical data network includes additional features toenable the traffic passing through the surgical data network to bemonitored and to configure each port in the network hub 200061 ornetwork switch 20062. An intelligent surgical data network may bereferred to as a manageable hub or switch. A switching hub reads thedestination address of each packet and then forwards the packet to thecorrect port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 20065. The network hub 20061 and/or thenetwork switch 20062 may be coupled to a network router 20066 to connectthe devices 1 a-1 n to the cloud computing system 20064 or the localcomputer system 20063. Data associated with the devices 1 a-1 n may betransferred to cloud-based computers via the router for remote dataprocessing and manipulation. Data associated with the devices 1 a-1 nmay also be transferred to the local computer system 20063 for localdata processing and manipulation. Modular devices 2 a-2 m located in thesame operating theater also may be coupled to a network switch 20062.The network switch 20062 may be coupled to the network hub 20061 and/orthe network router 20066 to connect the devices 2 a-2 m to the cloud20064. Data associated with the devices 2 a-2 m may be transferred tothe cloud computing system 20064 via the network router 20066 for dataprocessing and manipulation. Data associated with the devices 2 a-2 mmay also be transferred to the local computer system 20063 for localdata processing and manipulation.

The wearable sensing system 20011 may include one or more sensingsystems 20069. The sensing systems 20069 may include an HCP sensingsystem and/or a patient sensing system. The one or more sensing systems20069 may be in communication with the computer system 20063 of asurgical hub system 20060 or the cloud server 20067 directly via one ofthe network routers 20066 or via a network hub 20061 or networkswitching 20062 that is in communication with the network routers 20066.

The sensing systems 20069 may be coupled to the network router 20066 toconnect to the sensing systems 20069 to the local computer system 20063and/or the cloud computing system 20064. Data associated with thesensing systems 20069 may be transferred to the cloud computing system20064 via the network router 20066 for data processing and manipulation.Data associated with the sensing systems 20069 may also be transferredto the local computer system 20063 for local data processing andmanipulation.

As illustrated in FIG. 4 , the surgical hub system 20060 may be expandedby interconnecting multiple network hubs 20061 and/or multiple networkswitches 20062 with multiple network routers 20066. The modularcommunication hub 20065 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 20063 also may be contained in a modular control tower.The modular communication hub 20065 may be connected to a display 20068to display images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module coupled to an endoscope, a generator module coupled to anenergy-based surgical device, a smoke evacuation module, asuction/irrigation module, a communication module, a processor module, astorage array, a surgical device coupled to a display, and/or anon-contact sensor module, among other modular devices that may beconnected to the modular communication hub 20065 of the surgical datanetwork.

In one aspect, the surgical hub system 20060 illustrated in FIG. 4 maycomprise a combination of network hub(s), network switch(es), andnetwork router(s) connecting the devices 1 a-1 n/2 a-2 m or the sensingsystems 20069 to the cloud-base system 20064. One or more of the devices1 a-1 n/2 a-2 m or the sensing systems 20069 coupled to the network hub20061 or network switch 20062 may collect data in real-time and transferthe data to cloud computers for data processing and manipulation. Itwill be appreciated that cloud computing relies on sharing computingresources rather than having local servers or personal devices to handlesoftware applications. The word “cloud” may be used as a metaphor for“the Internet,” although the term is not limited as such. Accordingly,the term “cloud computing” may be used herein to refer to “a type ofInternet-based computing,” where different services-such as servers,storage, and applications—are delivered to the modular communication hub20065 and/or computer system 20063 located in the surgical theater(e.g., a fixed, mobile, temporary, or field operating room or space) andto devices connected to the modular communication hub 20065 and/orcomputer system 20063 through the Internet. The cloud infrastructure maybe maintained by a cloud service provider. In this context, the cloudservice provider may be the entity that coordinates the usage andcontrol of the devices 1 a-1 n/2 a-2 m located in one or more operatingtheaters. The cloud computing services can perform a large number ofcalculations based on the data gathered by smart surgical instruments,robots, sensing systems, and other computerized devices located in theoperating theater. The hub hardware enables multiple devices, sensingsystems, and/or connections to be connected to a computer thatcommunicates with the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network can provideimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This may include localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloudcomputing system 20064 or the local computer system 20063 or both fordata processing and manipulation including image processing andmanipulation. The data may be analyzed to improve surgical procedureoutcomes by determining if further treatment, such as the application ofendoscopic intervention, emerging technologies, a targeted radiation,targeted intervention, and precise robotics to tissue-specific sites andconditions, may be pursued. Such data analysis may further employoutcome analytics processing and using standardized approaches mayprovide beneficial feedback to either confirm surgical treatments andthe behavior of the surgeon or suggest modifications to surgicaltreatments and the behavior of the surgeon.

Applying cloud computer data processing techniques on the measurementdata collected by the sensing systems 20069, the surgical data networkcan provide improved surgical outcomes, improved recovery outcomes,reduced costs, and improved patient satisfaction. At least some of thesensing systems 20069 may be employed to assess physiological conditionsof a surgeon operating on a patient or a patient being prepared for asurgical procedure or a patient recovering after a surgical procedure.The cloud-based computing system 20064 may be used to monitor biomarkersassociated with a surgeon or a patient in real-time and to generatesurgical plans based at least on measurement data gathered prior to asurgical procedure, provide control signals to the surgical instrumentsduring a surgical procedure, and notify a patient of a complicationduring post-surgical period.

The operating theater devices 1 a-1 n may be connected to the modularcommunication hub 20065 over a wired channel or a wireless channeldepending on the configuration of the devices 1 a-1 n to a network hub20061. The network hub 20061 may be implemented, in one aspect, as alocal network broadcast device that works on the physical layer of theOpen System Interconnection (OSI) model. The network hub may provideconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 20061 may collect data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 20061 may not store any media access control/Internet Protocol(MAC/IP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 20061. The network hub20061 may not have routing tables or intelligence regarding where tosend information and broadcasts all network data across each connectionand to a remote server 20067 of the cloud computing system 20064. Thenetwork hub 20061 can detect basic network errors such as collisions buthaving all information broadcast to multiple ports can be a securityrisk and cause bottlenecks.

The operating theater devices 2 a-2 m may be connected to a networkswitch 20062 over a wired channel or a wireless channel. The networkswitch 20062 works in the data link layer of the OSI model. The networkswitch 20062 may be a multicast device for connecting the devices 2 a-2m located in the same operating theater to the network. The networkswitch 20062 may send data in the form of frames to the network router20066 and may work in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 20062. The networkswitch 20062 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 20061 and/or the network switch 20062 may be coupled tothe network router 20066 for connection to the cloud computing system20064. The network router 20066 works in the network layer of the OSImodel. The network router 20066 creates a route for transmitting datapackets received from the network hub 20061 and/or network switch 20062to cloud-based computer resources for further processing andmanipulation of the data collected by any one of or all the devices 1a-1 n/2 a-2 m and wearable sensing system 20011. The network router20066 may be employed to connect two or more different networks locatedin different locations, such as, for example, different operatingtheaters of the same healthcare facility or different networks locatedin different operating theaters of different healthcare facilities. Thenetwork router 20066 may send data in the form of packets to the cloudcomputing system 20064 and works in full duplex mode. Multiple devicescan send data at the same time. The network router 20066 may use IPaddresses to transfer data.

In an example, the network hub 20061 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 20061 may include wired or wirelesscapabilities to receive information over a wired channel or a wirelesschannel. In one aspect, a wireless USB short-range, high-bandwidthwireless radio communication protocol may be employed for communicationbetween the devices 1 a-1 n and devices 2 a-2 m located in the operatingtheater.

In examples, the operating theater devices 1 a-1 n/2 a-2 m and/or thesensing systems 20069 may communicate to the modular communication hub20065 via Bluetooth wireless technology standard for exchanging dataover short distances (using short-wavelength UHF radio waves in the ISMband from 2.4 to 2.485 GHz) from fixed and mobile devices and buildingpersonal area networks (PANs). The operating theater devices 1 a-1 n/2a-2 m and/or the sensing systems 20069 may communicate to the modularcommunication hub 20065 via a number of wireless or wired communicationstandards or protocols, including but not limited to Bluetooth,Low-Energy Bluetooth, near-field communication (NFC), Wi-Fi (IEEE 802.11family), WiMAX (IEEE 802.16 family), IEEE 802.20, new radio (NR),long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM,GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as anyother wireless and wired protocols that are designated as 3G, 4G, 5G,and beyond. The computing module may include a plurality ofcommunication modules. For instance, a first communication module may bededicated to shorter-range wireless communications such as Wi-Fi andBluetooth Low-Energy Bluetooth, Bluetooth Smart, and a secondcommunication module may be dedicated to longer-range wirelesscommunications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, HSPA+,HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, and others.

The modular communication hub 20065 may serve as a central connectionfor one or more of the operating theater devices 1 a-1 n/2 a-2 m and/orthe sensing systems 20069 and may handle a data type known as frames.Frames may carry the data generated by the devices 1 a-1 n/2 a-2 mand/or the sensing systems 20069. When a frame is received by themodular communication hub 20065, it may be amplified and/or sent to thenetwork router 20066, which may transfer the data to the cloud computingsystem 20064 or the local computer system 20063 by using a number ofwireless or wired communication standards or protocols, as describedherein.

The modular communication hub 20065 can be used as a standalone deviceor be connected to compatible network hubs 20061 and network switches20062 to form a larger network. The modular communication hub 20065 canbe generally easy to install, configure, and maintain, making it a goodoption for networking the operating theater devices 1 a-1 n/2 a-2 m.

FIG. 5 illustrates a computer-implemented interactive surgical system20070 that may be a part of the Surgical system 20002. Thecomputer-implemented interactive surgical system 20070 is similar inmany respects to the HCP sensing system 20002. For example, thecomputer-implemented interactive surgical system 20070 may include oneor more surgical sub-systems 20072, which are similar in many respectsto the Surgical systems 20002. Each sub-surgical system 20072 mayinclude at least one surgical hub 20076 in communication with a cloudcomputing system 20064 that may include a remote server 20077 and aremote storage 20078. In one aspect, the computer-implementedinteractive surgical system 20070 may include a modular control 20085connected to multiple operating theater devices such as sensing systems20001, intelligent surgical instruments, robots, and other computerizeddevices located in the operating theater.

As illustrated in the example of FIG. 5 , the modular control 20085 maybe coupled to an imaging module 20088 that may be coupled to anendoscope 20087, a generator module 20090 that may be coupled to anenergy device 20089, a smoke evacuator module 20001, asuction/irrigation module 20092, a communication module 20097, aprocessor module 20093, a storage array 20094, a smart device/instrument20095 optionally coupled to a display 20086 and 20084 respectively, anda non-contact sensor module 20096. The non-contact sensor module 20006may measure the dimensions of the operating theater and generate a mapof the surgical theater using, ultrasonic, laser-type, and/or the like,non-contact measurement devices. Other distance sensors can be employedto determine the bounds of an operating room. An ultrasound-basednon-contact sensor module may scan the operating theater by transmittinga burst of ultrasound and receiving the echo when it bounces off theperimeter walls of an operating theater as described under the heading“Surgical Hub Spatial Awareness Within an Operating Room” in U.S.Provisional Patent Application Ser. No. 62/611,341, tided INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, which is herein incorporated byreference in its entirety. The sensor module may be configured todetermine the size of the operating theater and to adjustBluetooth-pairing distance limits. A laser-based non-contact sensormodule may scan the operating theater by transmitting laser lightpulses, receiving laser light pulses that bounce off the perimeter wallsof the operating theater, and comparing the phase of the transmittedpulse to the received pulse to determine the size of the operatingtheater and to adjust Bluetooth pairing distance limits, for example.

The modular control 20085 may also be in communication with one or moresensing systems 20069 and an environmental sensing system 20015. Thesensing systems 20069 may be connected to the modular control 20085either directly via a router or via the communication module 20097. Theoperating theater devices may be coupled to cloud computing resourcesand data storage via the modular control 20085. A robot surgical hub20082 also may be connected to the modular control 20085 and to thecloud computing resources. The devices/instruments 20095 or 20084, humaninterface system 20080, among others, may be coupled to the modularcontrol 20085 via wired or wireless communication standards orprotocols, as described herein. The human interface system 20080 mayinclude a display sub-system and a notification sub-system. The modularcontrol 20085 may be coupled to a hub display 20081 (e.g., monitor,screen) to display and overlay images received from the imaging module20088, device/instrument display 20086, and/or other human interfacesystems 20080. The hub display 20081 also may display data received fromdevices connected to the modular control 20085 in conjunction withimages and overlaid images.

FIG. 6 illustrates a logical diagram of a control system 20220 of asurgical instrument or a surgical tool in accordance with one or moreaspects of the present disclosure. The surgical instrument or thesurgical tool may be configurable. The surgical instrument may includesurgical fixtures specific to the procedure at-hand, such as imagingdevices, surgical staplers, energy devices, endocutter devices, or thelike. For example, the surgical instrument may include any of a poweredstapler, a powered stapler generator, an energy device, an advancedenergy device, an advanced energy jaw device, an endocutter clamp, anenergy device generator, an in-operating-room imaging system, a smokeevacuator, a suction-irrigation device, an insufflation system, or thelike. The system 20220 may comprise a control circuit. The controlcircuit may include a microcontroller 20221 comprising a processor 20222and a memory 20223. One or more of sensors 20225, 20226, 20227, forexample, provide real-time feedback to the processor 20222. A motor20230, driven by a motor driver 20229, operably couples a longitudinallymovable displacement member to drive the I-beam knife element. Atracking system 20228 may be configured to determine the position of thelongitudinally movable displacement member. The position information maybe provided to the processor 20222, which can be programmed orconfigured to determine the position of the longitudinally movable drivemember as well as the position of a firing member, firing bar, andI-beam knife element. Additional motors may be provided at the tooldriver interface to control I-beam firing, closure tube travel, shaftrotation, and articulation. A display 20224 may display a variety ofoperating conditions of the instruments and may include touch screenfunctionality for data input. Information displayed on the display 20224may be overlaid with images acquired via endoscopic imaging modules.

The microcontroller 20221 may be any single-core or multicore processorsuch as those known under the trade name ARM Cortex by TexasInstruments. In one aspect, the main microcontroller 20221 may be anLM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare®,software, a 2 KB EEPROM, one or more PWM modules, one or more QEIanalogs, and/or one or more 12-bit ADCs with 12 analog input channels,details of which are available for the product datasheet.

The microcontroller 20221 may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x, known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

The microcontroller 20221 may be programmed to perform various functionssuch as precise control over the speed and position of the knife andarticulation systems. In one aspect, the microcontroller 20221 mayinclude a processor 20222 and a memory 20223. The electric motor 20230may be a brushed direct current (DC) motor with a gearbox and mechanicallinks to an articulation or knife system. In one aspect, a motor driver20229 may be an A3941 available from Allegro Microsystems, Inc. Othermotor drivers may be readily substituted for use in the tracking system20228 comprising an absolute positioning system. A detailed descriptionof an absolute positioning system is described in U.S. PatentApplication Publication No. 2017/0296213, titled SYSTEMS AND METHODS FORCONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, which publishedon Oct. 19, 2017, which is herein incorporated by reference in itsentirety.

The microcontroller 20221 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 20221 may be configured to compute aresponse in the software of the microcontroller 20221. The computedresponse may be compared to a measured response of the actual system toobtain an “observed” response, which is used for actual feedbackdecisions. The observed response may be a favorable, tuned value thatbalances the smooth, continuous nature of the simulated response withthe measured response, which can detect outside influences on thesystem.

The motor 20230 may be controlled by the motor driver 20229 and can beemployed by the firing system of the surgical instrument or tool. Invarious forms, the motor 20230 may be a brushed DC driving motor havinga maximum rotational speed of approximately 25,000 RPM. In someexamples, the motor 20230 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 20229 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 20230can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery which mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable. In at least one example, the batterycells can be lithium-ion batteries which can be couplable to andseparable from the power assembly.

The motor driver 20229 may be an A3941 available from AllegroMicrosystems, Inc. A3941 may be a full-bridge controller for use withexternal N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 20229 may comprise a unique charge pumpregulator that can provide full (>10 V) gate drive for battery voltagesdown to 7 V and can allow the A3941 to operate with a reduced gatedrive, down to 5.5 V. A bootstrap capacitor may be employed to providethe above battery supply voltage required for N-channel MOSFETs. Aninternal charge pump for the high-side drive may allow DC (100% dutycycle) operation. The full bridge can be driven in fast or slow decaymodes using diode or synchronous rectification. In the slow decay mode,current recirculation can be through the high-side or the low-side FETs.The power FETs may be protected from shoot-through byresistor-adjustable dead time. Integrated diagnostics provideindications of undervoltage, overtemperature, and power bridge faultsand can be configured to protect the power MOSFETs under most shortcircuit conditions. Other motor drivers may be readily substituted foruse in the tracking system 20228 comprising an absolute positioningsystem.

The tracking system 20228 may comprise a controlled motor drive circuitarrangement comprising a position sensor 20225 according to one aspectof this disclosure. The position sensor 20225 for an absolutepositioning system may provide a unique position signal corresponding tothe location of a displacement member. In some examples, thedisplacement member may represent a longitudinally movable drive membercomprising a rack of drive teeth for meshing engagement with acorresponding drive gear of a gear reducer assembly. In some examples,the displacement member may represent the firing member, which could beadapted and configured to include a rack of drive teeth. In someexamples, the displacement member may represent a firing bar or theI-beam, each of which can be adapted and configured to include a rack ofdrive teeth. Accordingly, as used herein, the term displacement membercan be used generically to refer to any movable member of the surgicalinstrument or tool such as the drive member, the firing member, thefiring bar, the I-beam, or any element that can be displaced. In oneaspect, the longitudinally movable drive member can be coupled to thefiring member, the firing bar, and the I-beam. Accordingly, the absolutepositioning system can, in effect, track the linear displacement of theI-beam by tracking the linear displacement of the longitudinally movabledrive member. In various aspects, the displacement member may be coupledto any position sensor 20225 suitable for measuring linear displacement.Thus, the longitudinally movable drive member, the firing member, thefiring bar, or the I-beam, or combinations thereof, may be coupled toany suitable linear displacement sensor. Linear displacement sensors mayinclude contact or non-contact displacement sensors. Linear displacementsensors may comprise linear variable differential transformers (LVDT),differential variable reluctance transducers (DVRT), a slidepotentiometer, a magnetic sensing system comprising a movable magnet anda series of linearly arranged Hall effect sensors, a magnetic sensingsystem comprising a fixed magnet and a series of movable, linearlyarranged Hall effect sensors, an optical sensing system comprising amovable light source and a series of linearly arranged photo diodes orphoto detectors, an optical sensing system comprising a fixed lightsource and a series of movable linearly, arranged photodiodes orphotodetectors, or any combination thereof.

The electric motor 20230 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack, of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 20225 element corresponds to somelinear longitudinal translation of the displacement member. Anarrangement of gearing and sensors can be connected to the linearactuator, via a rack and pinion arrangement, or a rotary actuator, via aspur gear or other connection. A power source may supply power to theabsolute positioning system and an output indicator may display theoutput of the absolute positioning system. The displacement member mayrepresent the longitudinally movable drive member comprising a rack ofdrive teeth formed thereon for meshing engagement with a correspondingdrive gear of the gear reducer assembly. The displacement member mayrepresent the longitudinally movable firing member, firing bar, I-beam,or combinations thereof.

A single revolution of the sensor element associated with the positionsensor 20225 may be equivalent to a longitudinal linear displacement d1of the displacement member, where d1 is the longitudinal linear distancethat the displacement member moves from point “a” to point “b” after asingle revolution of the sensor element coupled to the displacementmember. The sensor arrangement may be connected via a gear reductionthat results in the position sensor 20225 completing one or morerevolutions for the full stroke of the displacement member. The positionsensor 20225 may complete multiple revolutions for the full stroke ofthe displacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 20225. The state of the switches may be fed back to themicrocontroller 20221 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d1+d2+ . .. dn of the displacement member. The output of the position sensor 20225is provided to the microcontroller 20221. The position sensor 20225 ofthe sensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 20225 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors may encompass many aspects of physics and electronics.The technologies used for magnetic field sensing may include searchcoil, fluxgate, optically pumped, nuclear precession, SQUID,Hall-effect, anisotropic magnetoresistance, giant magnetoresistance,magnetic tunnel junctions, giant magnetoimpedance,magnetostrictive/piezoelectric composites, magnetodiode,magnetotransistor, fiber-optic, magneto-optic, andmicroelectromechanical systems-based magnetic sensors, among others.

The position sensor 20225 for the tracking system 20228 comprising anabsolute positioning system may comprise a magnetic rotary absolutepositioning system. The position sensor 20225 may be implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 20225 is interfaced withthe microcontroller 20221 to provide an absolute positioning system. Theposition sensor 20225 may be a low-voltage and low-power component andmay include four Hall-effect elements in an area of the position sensor20225 that may be located above a magnet. A high-resolution ADC and asmart power management controller may also be provided on the chip. Acoordinate rotation digital computer (CORDIC) processor, also known asthe digit-by-digit method and Volder's algorithm, may be provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bit-shift, and table lookup operations. The angle position, alarm bits,and magnetic field information may be transmitted over a standard serialcommunication interface, such as a serial peripheral interface (SPI)interface, to the microcontroller 20221. The position sensor 20225 mayprovide 12 or 14 bits of resolution. The position sensor 20225 may be anAS5055 chip provided in a small QFN 16-pin 4×4×0.85 nm package.

The tracking system 20228 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 20225. In some aspects, theother sensor(s) can include sensor arrangements such as those describedin U.S. Pat. No. 9,345,481, tided STAPLE CARTRIDGE TISSUE THICKNESSSENSOR SYSTEM, which issued on May 24, 2016, which is hereinincorporated by reference in its entirety; U.S. Patent ApplicationPublication No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESSSENSOR SYSTEM, which published on Sep. 18, 2014, which is hereinincorporated by reference in its entirety; and U.S. patent applicationSer. No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed lune 20,2017, which is herein incorporated by reference in its entirety. In adigital signal processing system, an absolute positioning system iscoupled to a digital data acquisition system where the output of theabsolute positioning system will have a finite resolution and samplingfrequency. The absolute positioning system may comprise acompare-and-combine circuit to combine a computed response with ameasured response using algorithms, such as a weighted average and atheoretical control loop, that drive the computed response towards themeasured response. The computed response of the physical system may takeinto account properties like mass, inertia, viscous friction, inductanceresistance, etc., to predict what the states and outputs of the physicalsystem will be by knowing the input.

The absolute positioning system may provide an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 20230 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 20226, such as, for example, a strain gauge or a micro-straingauge, may be configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain may beconverted to a digital signal and provided to the processor 20222.Alternatively, or in addition to the sensor 20226, a sensor 20227, suchas, for example, a load sensor, can measure the closure force applied bythe closure drive system to the anvil. The sensor 20227, such as, forexample, a load sensor, can measure the firing force applied to anI-beam in a firing stroke of the surgical instrument or tool. The I-beamis configured to engage a wedge sled, which is configured to upwardlycam staple drivers to force out staples into deforming contact with ananvil. The I-beam also may include a sharpened cutting edge that can beused to sever tissue as the I-beam is advanced distally by the firingbar. Alternatively, a current sensor 20231 can be employed to measurethe current drawn by the motor 20230. The force required to advance thefiring member can correspond to the current drawn by the motor 20230,for example. The measured force may be converted to a digital signal andprovided to the processor 20222.

For example, the strain gauge sensor 20226 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector may comprise a strain gaugesensor 20226, such as, for example, a micro-strain gauge, that can beconfigured to measure one or more parameters of the end effector, forexample. In one aspect, the strain gauge sensor 20226 can measure theamplitude or magnitude of the strain exerted on a jaw member of an endeffector during a clamping operation, which can be indicative of thetissue compression. The measured strain can be converted to a digitalsignal and provided to a processor 20222 of the microcontroller 20221. Aload sensor 20227 can measure the force used to operate the knifeelement, for example, to cut the tissue captured between the anvil andthe staple cartridge. A magnetic field sensor can be employed to measurethe thickness of the captured tissue. The measurement of the magneticfield sensor also may be converted to a digital signal and provided tothe processor 20222.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 20226, 20227, can be used by themicrocontroller 20221 to characterize the selected position of thefiring member and/or the corresponding value of the speed of the firingmember. In one instance, a memory 20223 may store a technique, anequation, and/or a lookup table which can be employed by themicrocontroller 20221 in the assessment.

The control system 20220 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub 20065 as shown in FIG. 5 .

FIG. 7 illustrates an example surgical system 20280 in accordance withthe present disclosure and may include a surgical instrument 20282 thatcan be in communication with a console 20294 or a portable device 20296through a local area network 20292 and/or a cloud network 20293 via awired and/or wireless connection. The console 20294 and the portabledevice 20296 may be any suitable computing device. The surgicalinstrument 20282 may include a handle 20297, an adapter 20285, and aloading unit 20287. The adapter 20285 releasably couples to the handle20297 and the loading unit 20287 releasably couples to the adapter 20285such that the adapter 20285 transmits a force from a drive shaft to theloading unit 20287. The adapter 20285 or the loading unit 20287 mayinclude a force gauge (not explicitly shown) disposed therein to measurea force exerted on the loading unit 20287. The loading unit 20287 mayinclude an end effector 20289 having a first jaw 20291 and a second jaw20290. The loading unit 20287 may be an in-situ loaded or multi-firingloading unit (MF-LU) that allows a clinician to fire a plurality offasteners multiple times without requiring the loading unit 20287 to beremoved from a surgical site to reload the loading unit 20287.

The first and second jaws 20291, 20290 may be configured to clamp tissuetherebetween, fire fasteners through the clamped tissue, and sever theclamped tissue. The first jaw 20291 may be configured to fire at leastone fastener a plurality of times or may be configured to include areplaceable multi-fire fastener cartridge including a plurality offasteners (e.g., staples, clips, etc.) that may be fired more than onetime prior to being replaced. The second jaw 20290 may include an anvilthat deforms or otherwise secures the fasteners, as the fasteners areejected from the multi-fire fastener cartridge.

The handle 20297 may include a motor that is coupled to the drive shaftto affect rotation of the drive shaft. The handle 20297 may include acontrol interface to selectively activate the motor. The controlinterface may include buttons, switches, levers, sliders, touchscreens,and any other suitable input mechanisms or user interfaces, which can beengaged by a clinician to activate the motor.

The control interface of the handle 20297 may be in communication with acontroller 20298 of the handle 20297 to selectively activate the motorto affect rotation of the drive shafts. The controller 20298 may bedisposed within the handle 20297 and may be configured to receive inputfrom the control interface and adapter data from the adapter 20285 orloading unit data from the loading unit 20287. The controller 20298 mayanalyze the input from the control interface and the data received fromthe adapter 20285 and/or loading unit 20287 to selectively activate themotor. The handle 20297 may also include a display that is viewable by aclinician during use of the handle 20297. The display may be configuredto display portions of the adapter or loading unit data before, during,or after firing of the instrument 20282.

The adapter 20285 may include an adapter identification device 20284disposed therein and the loading unit 20287 may include a loading unitidentification device 20288 disposed therein. The adapter identificationdevice 20284 may be in communication with the controller 20298, and theloading unit identification device 20288 may be in communication withthe controller 20298. It will be appreciated that the loading unitidentification device 20288 may be in communication with the adapteridentification device 20284, which relays or passes communication fromthe loading unit identification device 20288 to the controller 20298.

The adapter 20285 may also include a plurality of sensors 20286 (oneshown) disposed thereabout to detect various conditions of the adapter20285 or of the environment (e.g., if the adapter 20285 is connected toa loading unit, if the adapter 20285 is connected to a handle, if thedrive shafts are rotating, the torque of the drive shafts, the strain ofthe drive shafts, the temperature within the adapter 20285, a number offirings of the adapter 20285, a peak force of the adapter 20285 duringfiring, a total amount of force applied to the adapter 20285, a peakretraction force of the adapter 20285, a number of pauses of the adapter20285 during firing, etc.). The plurality of sensors 20286 may providean input to the adapter identification device 20284 in the form of datasignals. The data signals of the plurality of sensors 20286 may bestored within or be used to update the adapter data stored within theadapter identification device 20284. The data signals of the pluralityof sensors 20286 may be analog or digital. The plurality of sensors20286 may include a force gauge to measure a force exerted on theloading unit 20287 during firing.

The handle 20297 and the adapter 20285 can be configured to interconnectthe adapter identification device 20284 and the loading unitidentification device 20288 with the controller 20298 via an electricalinterface. The electrical interface may be a direct electrical interface(i.e., include electrical contacts that engage one another to transmitenergy and signals therebetween). Additionally, or alternatively, theelectrical interface may be a non-contact electrical interface towirelessly transmit energy and signals therebetween (e.g., inductivelytransfer). It is also contemplated that the adapter identificationdevice 20284 and the controller 20298 may be in wireless communicationwith one another via a wireless connection separate from the electricalinterface.

The handle 20297 may include a transceiver 20283 that is configured totransmit instrument data from the controller 20298 to other componentsof the system 20280 (e.g., the LAN 20292, the cloud 20293, the console20294, or the portable device 20296). The controller 20298 may alsotransmit instrument data and/or measurement data associated with one ormore sensors 20286 to a surgical hub. The transceiver 20283 may receivedata (e.g., cartridge data, loading unit data, adapter data, or othernotifications) from the surgical hub 20270. The transceiver 20283 mayreceive data (e.g., cartridge data, loading unit data, or adapter data)from the other components of the system 20280. For example, thecontroller 20298 may transmit instrument data including a serial numberof an attached adapter (e.g., adapter 20285) attached to the handle20297, a serial number of a loading unit (e.g., loading unit 20287)attached to the adapter 20285, and a serial number of a multi-firefastener cartridge loaded into the loading unit to the console 20294.Thereafter, the console 20294 may transmit data (e.g., cartridge data,loading unit data, or adapter data) associated with the attachedcartridge, loading unit, and adapter, respectively, back to thecontroller 20298. The controller 20298 can display messages on the localinstrument display or transmit the message, via transceiver 20283, tothe console 20294 or the portable device 20296 to display the message onthe display 20295 or portable device screen, respectively.

FIG. 8 illustrates a diagram of a situationally aware surgical system5100, in accordance with at least one aspect of the present disclosure.The data sources 5126 may include, for example, the modular devices 5102(which can include sensors configured to detect parameters associatedwith the patient, HCPs and environment and/or the modular deviceitself), databases 5122 (e.g., an EMR database containing patientrecords), patient monitoring devices 5124 (e.g., a blood pressure (BP)monitor and an electrocardiography (EKG) monitor), HCP monitoringdevices 35510, and/or environment monitoring devices 35512. The surgicalhub 5104 can be configured to derive the contextual informationpertaining to the surgical procedure from the data based upon, forexample, the particular combination(s) of received data or theparticular order in which the data is received from the data sources5126. The contextual information inferred from the received data caninclude, for example, the type of surgical procedure being performed,the particular step of the surgical procedure that the surgeon isperforming, the type of tissue being operated on, or the body cavitythat is the subject of the procedure. This ability by some aspects ofthe surgical hub 5104 to derive or infer information related to thesurgical procedure from received data can be referred to as “situationalawareness.” For example, the surgical hub 5104 can incorporate asituational awareness system, which is the hardware and/or programmingassociated with the surgical hub 5104 that derives contextualinformation pertaining to the surgical procedure from the received dataand/or a surgical plan information received from the edge computingsystem 35514 or an enterprise cloud server 35516.

The situational awareness system of the surgical hub 5104 can beconfigured to derive the contextual information from the data receivedfrom the data sources 5126 in a variety of different ways. For example,the situational awareness system can include a pattern recognitionsystem, or machine learning system (e.g., an artificial neural network),that has been trained on training data to correlate various inputs(e.g., data from database(s) 5122, patient monitoring devices 5124,modular devices 5102, HCP monitoring devices 35510, and/or environmentmonitoring devices 35512) to corresponding contextual informationregarding a surgical procedure. A machine learning system can be trainedto accurately derive contextual information regarding a surgicalprocedure from the provided inputs. In examples, the situationalawareness system can include a lookup table storing pre-characterizedcontextual information regarding a surgical procedure in associationwith one or more inputs (or ranges of inputs) corresponding to thecontextual information. In response to a query with one or more inputs,the lookup table can return the corresponding contextual information forthe situational awareness system for controlling the modular devices5102. In examples, the contextual information received by thesituational awareness system of the surgical hub 5104 can be associatedwith a particular control adjustment or set of control adjustments forone or more modular devices 5102. In examples, the situational awarenesssystem can include a further machine learning system, lookup table, orother such system, which generates or retrieves one or more controladjustments for one or more modular devices 5102 when provided thecontextual information as input.

A surgical hub 5104 incorporating a situational awareness system canprovide a number of benefits for the surgical system 5100. One benefitmay include improving the interpretation of sensed and collected data,which would in turn improve the processing accuracy and/or the usage ofthe data during the course of a surgical procedure. To return to aprevious example, a situationally aware surgical hub 5104 coulddetermine what type of tissue was being operated on; therefore, when anunexpectedly high force to close the surgical instrument's end effectoris detected, the situationally aware surgical hub 5104 could correctlyramp up or ramp down the motor of the surgical instrument for the typeof tissue.

The type of tissue being operated can affect the adjustments that aremade to the compression rate and load thresholds of a surgical staplingand cutting instrument for a particular tissue gap measurement. Asituationally aware surgical hub 5104 could infer whether a surgicalprocedure being performed is a thoracic or an abdominal procedure,allowing the surgical hub 5104 to determine whether the tissue clampedby an end effector of the surgical stapling and cutting instrument islung (for a thoracic procedure) or stomach (for an abdominal procedure)tissue. The surgical hub 5104 could then adjust the compression rate andload thresholds of the surgical stapling and cutting instrumentappropriately for the type of tissue.

The type of body cavity being operated in during an insufflationprocedure can affect the function of a smoke evacuator. A situationallyaware surgical hub 5104 could determine whether the surgical site isunder pressure (by determining that the surgical procedure is utilizinginsufflation) and determine the procedure type. As a procedure type canbe generally performed in a specific body cavity, the surgical hub 5104could then control the motor rate of the smoke evacuator appropriatelyfor the body cavity being operated in. Thus, a situationally awaresurgical hub 5104 could provide a consistent amount of smoke evacuationfor both thoracic and abdominal procedures.

The type of procedure being performed can affect the optimal energylevel for an ultrasonic surgical instrument or radio frequency (RE)electrosurgical instrument to operate at. Arthroscopic procedures, forexample, may require higher energy levels because the end effector ofthe ultrasonic surgical instrument or RF electrosurgical instrument isimmersed in fluid. A situationally aware surgical hub 5104 coulddetermine whether the surgical procedure is an arthroscopic procedure.The surgical hub 5104 could then adjust the RF power level or theultrasonic amplitude of the generator (e.g., “energy level”) tocompensate for the fluid filled environment. Relatedly, the type oftissue being operated on can affect the optimal energy level for anultrasonic surgical instrument or RF electrosurgical instrument tooperate at. A situationally aware surgical hub 5104 could determine whattype of surgical procedure is being performed and then customize theenergy level for the ultrasonic surgical instrument or RFelectrosurgical instrument, respectively, according to the expectedtissue profile for the surgical procedure. Furthermore, a situationallyaware surgical hub 5104 can be configured to adjust the energy level forthe ultrasonic surgical instrument or RF electrosurgical instrumentthroughout the course of a surgical procedure, rather than just on aprocedure-by-procedure basis. A situationally aware surgical hub 5104could determine what step of the surgical procedure is being performedor will subsequently be performed and then update the control algorithmsfor the generator and/or ultrasonic surgical instrument or RFelectrosurgical instrument to set the energy level at a valueappropriate for the expected tissue type according to the surgicalprocedure step.

In examples, data can be drawn from additional data sources 5126 toimprove the conclusions that the surgical hub 5104 draws from one datasource 5126. A situationally aware surgical hub 5104 could augment datathat it receives from the modular devices 5102 with contextualinformation that it has built up regarding the surgical procedure fromother data sources 5126. For example, a situationally aware surgical hub5104 can be configured to determine whether hemostasis has occurred(e.g., whether bleeding at a surgical site has stopped) according tovideo or image data received from a medical imaging device. The surgicalhub 5104 can be further configured to compare a physiologic measurement(e.g., blood pressure sensed by a BP monitor communicably connected tothe surgical hub 5104) with the visual or image data of hemostasis(e.g., from a medical imaging device communicably coupled to thesurgical hub 5104) to make a determination on the integrity of thestaple line or tissue weld. The situational awareness system of thesurgical hub 5104 can consider the physiological measurement data toprovide additional context in analyzing the visualization data. Theadditional context can be useful when the visualization data may beinconclusive or incomplete on its own.

For example, a situationally aware surgical hub 5104 could proactivelyactivate the generator to which an RF electrosurgical instrument isconnected if it determines that a subsequent step of the procedurerequires the use of the instrument. Proactively activating the energysource can allow the instrument to be ready for use as soon as thepreceding step of the procedure is completed.

The situationally aware surgical hub 5104 could determine whether thecurrent or subsequent step of the surgical procedure requires adifferent view or degree of magnification on the display according tothe feature(s) at the surgical site that the surgeon is expected to needto view. The surgical hub 5104 could proactively change the displayedview (supplied by, e.g., a medical imaging device for the visualizationsystem) accordingly so that the display automatically adjusts throughoutthe surgical procedure.

The situationally aware surgical hub 5104 could determine which step ofthe surgical procedure is being performed or will subsequently beperformed and whether particular data or comparisons between data willbe required for that step of the surgical procedure. The surgical hub5104 can be configured to automatically call up data screens based uponthe step of the surgical procedure being performed, without waiting forthe surgeon to ask for the particular information.

Errors may be checked during the setup of the surgical procedure orduring the course of the surgical procedure. For example, thesituationally aware surgical hub 5104 could determine whether theoperating theater is setup properly or optimally for the surgicalprocedure to be performed. The surgical hub 5104 can be configured todetermine the type of surgical procedure being performed, retrieve thecorresponding checklists, product location, or setup needs (e.g., from amemory), and then compare the current operating theater layout to thestandard layout for the type of surgical procedure that the surgical hub5104 determines is being performed. In some exemplifications, thesurgical hub 5104 can compare the list of items for the procedure and/ora list of devices paired with the surgical hub 5104 to a recommended oranticipated manifest of items and/or devices for the given surgicalprocedure. If there are any discontinuities between the lists, thesurgical hub 5104 can provide an alert indicating that a particularmodular device 5102, patient monitoring device 5124, HCP monitoringdevices 35510, environment monitoring devices 35512, and/or othersurgical item is missing. In some examples, the surgical hub 5104 candetermine the relative distance or position of the modular devices 5102and patient monitoring devices 5124 via proximity sensors, for example.The surgical hub 5104 can compare the relative positions of the devicesto a recommended or anticipated layout for the particular surgicalprocedure. If there are any discontinuities between the layouts, thesurgical hub 5104 can be configured to provide an alert indicating thatthe current layout for the surgical procedure deviates from therecommended layout.

The situationally aware surgical hub 5104 could determine whether thesurgeon (or other HCP(s)) was making an error or otherwise deviatingfrom the expected course of action during the course of a surgicalprocedure. For example, the surgical hub 5104 can be configured todetermine the type of surgical procedure being performed, retrieve thecorresponding list of steps or order of equipment usage (e.g., from amemory), and then compare the steps being performed or the equipmentbeing used during the course of the surgical procedure to the expectedsteps or equipment for the type of surgical procedure that the surgicalhub 5104 determined is being performed. The surgical hub 5104 canprovide an alert indicating that an unexpected action is being performedor an unexpected device is being utilized at the particular step in thesurgical procedure.

The surgical instruments (and other modular devices 5102) may beadjusted for the particular context of each surgical procedure (such asadjusting to different tissue types) and validating actions during asurgical procedure. Next steps, data, and display adjustments may beprovided to surgical instruments (and other modular devices 5102) in thesurgical theater according to the specific context of the procedure.

A computing system may use redundant communication pathways forcommunicating surgical imaging feed(s). For example, surgical videofeed(s) may be sent via multiple video stream pathways to improveresilience of the feed.

FIGS. 9A-9C show an example visualization system 2108 that may beincorporated into a surgical system. The visualization system 2108 mayinclude an imaging control unit 2002 and a hand unit 2020. The imagingcontrol unit 2002 may include one or more illumination sources, a powersupply for the one or more illumination sources, one or more types ofdata communication interfaces (including USB, Ethernet, or wirelessinterfaces 2004), and one or more video outputs 2006. The imagingcontrol unit 2002 may further include an interface, such as a USBinterface 2010, configured to transmit integrated video and imagecapture data to a USB enabled device. The imaging control unit 2002 mayalso include one or more computational components including, withoutlimitation, a processor unit, a transitory memory unit, a non-transitorymemory unit, an image processing unit, a bus structure to form datalinks among the computational components, and any interface (e.g. inputand/or output) devices necessary to receive information from andtransmit information to components not included in the imaging controlunit. The non-transitory memory may further contain instructions thatwhen executed by the processor unit, may perform any number ofmanipulations of data that may be received from the hand unit 2020and/or computational devices not included in the imaging control unit.

The illumination sources may include a white light source 2012 and oneor more laser light sources. The imaging control unit 2002 may includeone or more optical and/or electrical interfaces for optical and/orelectrical communication with the hand unit 2020. The one or more laserlight sources may include, as non-limiting examples, any one or more ofa red laser light source, a green laser light source, a blue laser lightsource, an infrared laser light source, and an ultraviolet laser lightsource. In some non-limiting examples, the red laser light source maysource illumination having a peak wavelength that may range between 635nm and 660 nm, inclusive. Non-limiting examples of a red laser peakwavelength may include about 635 nm, about 640 nm, about 645 nm, about650 nm, about 655 nm, about 660 nm, or any value or range of valuestherebetween. In some non-limiting examples, the green laser lightsource may source illumination having a peak wavelength that may rangebetween 520 nm and 532 nm, inclusive. Non-limiting examples of a greenlaser peak wavelength may include about 520 nm, about 522 nm, about 524nm, about 526 nm, about 528 nm, about 530 nm, about 532 nm, or any valueor range of values therebetween. In some non-limiting examples, the bluelaser light source may source illumination having a peak wavelength thatmay range between 405 nm and 445 nm, inclusive. Non-limiting examples ofa blue laser peak wavelength may include about 405 nm, about 410 nm,about 415 nm, about 420 nm, about 425 nm, about 430 nm, about 435 nm,about 440 nm, about 445 nm, or any value or range of valuestherebetween. In some non-limiting examples, the infrared laser lightsource may source illumination having a peak wavelength that may rangebetween 750 nm and 3000 nm, inclusive. Non-limiting examples of aninfrared laser peak wavelength may include about 750 nm, about 1000 nm,about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250nm, about 250) nm, about 2750 nm, 3000 nm, or any value or range ofvalues therebetween. In some non-limiting examples, the ultravioletlaser light source may source illumination having a peak wavelength thatmay range between 200 nm and 360 nm, inclusive. Non-limiting examples ofan ultraviolet laser peak wavelength may include about 200 nm, about 220nm, about 240 nm, about 260 nm, about 280 nm, about 300 nm, about 320nm, about 340 nm, about 360 nm, or any value or range of valuestherebetween.

The hand unit 2020 may include a body 2021, a camera scope cable 2015attached to the body 2021, and an elongated camera probe 2024. The body2021 of the hand unit 2020 may include hand unit control buttons 2022 orother controls to permit a health professional using the hand unit 2020to control the operations of the hand unit 2020 or other components ofthe imaging control unit 2002, including, for example, the lightsources. The camera scope cable 2015 may include one or more electricalconductors and one or more optical fibers. The camera scope cable 2015may terminate with a camera head connector 2008 at a proximal end inwhich the camera head connector 2008 is configured to mate with the oneor more optical and/or electrical interfaces of the imaging control unit2002. The electrical conductors may supply power to the hand unit 2020,including the body 2021 and the elongated camera probe 2024, and/or toany electrical components internal to the hand unit 2020 including thebody 2021 and/or elongated camera probe 2024. The electrical conductorsmay also serve to provide bi-directional data communication between anyone or more components the hand unit 2020 and the imaging control unit2002. The one or more optical fibers may conduct illumination from theone or more illumination sources in the imaging control unit 2002through the hand unit body 2021 and to a distal end of the elongatedcamera probe 2024. In some non-limiting aspects, the one or more opticalfibers may also conduct light reflected or refracted from the surgicalsite to one or more optical sensors disposed in the elongated cameraprobe 2024, the hand unit body 2021, and/or the imaging control unit2002.

FIG. 9B (a top plan view) depicts in more detail some aspects of a handunit 2020 of the visualization system 2108. The hand unit body 2021 maybe constructed of a plastic material. The hand unit control buttons 2022or other controls may have a rubber overmolding to protect the controlswhile permitting them to be manipulated by the surgeon. The camera scopecable 2015 may have optical fibers integrated with electricalconductors, and the camera scope cable 2015 may have a protective andflexible overcoating such as PVC. In some non-limiting examples, thecamera scope cable 2015 may be about 10 ft. long to permit ease of useduring a surgical procedure. The length of the camera scope cable 2015may range from about 5 ft. to about 15 ft. Non-limiting examples of alength of the camera scope cable 2015 may be about 5 ft., about 6 ft.,about 7 ft., about 8 ft., about 9 ft., about 10 ft., about 11 ft., about12 ft., about 13 ft., about 14 ft., about 15 ft., or any length or rangeof lengths therebetween. The elongated camera probe 2024 may befabricated from a rigid material such as stainless steel. The elongatedcamera probe 2024 may be joined with the hand unit body 2021 via arotatable collar 2026. The rotatable collar 2026 may permit theelongated camera probe 2024 to be rotated with respect to the hand unitbody 2021. The elongated camera probe 2024 may terminate at a distal endwith a plastic window 2028 sealed with epoxy.

The side plan view of the hand unit, depicted in FIG. 9C illustratesthat a light or image sensor 2030 may be disposed at a distal end 2032 aof the elongated camera probe or within the hand unit body 2032 b. Thelight or image sensor 2030 may be dispose with additional opticalelements in the imaging control unit 2002. FIG. 9C depicts an example ofa light sensor 2030 comprising a CMOS image sensor 2034 disposed withina mount 2036 having a radius of about 4 mm. Although the CMOS imagesensor in FIG. 9C is depicted to be disposed within a mount 2036 havinga radius of about 4 mm, it may be recognized that such a sensor andmount combination may be of any useful size to be disposed within theelongated camera probe 2024, the hand unit body 2021, or in the imagecontrol unit 2002. Some non-limiting examples of such alternative mountsmay include a 5.5 mm mount 2136, a 4 mm mount 2136, a 2.7 mm mount 2136,and a 2 mm mount 2136. It may be recognized that the image sensor mayalso comprise a CCD image sensor. The CMOS or CCD sensor may comprise anarray of individual light sensing elements (pixels).

During a surgical procedure, a surgeon may be required to manipulatetissues to affect a desired medical outcome. The actions of the surgeonare limited by what is visually observable in the surgical site. Thus,the surgeon may not be aware, for example, of the disposition ofvascular structures that underlie the tissues being manipulated duringthe procedure.

Since the surgeon is unable to visualize the vasculature beneath asurgical site, the surgeon may accidentally sever one or more criticalblood vessels during the procedure.

Therefore, it is desirable to have a surgical visualization system thatcan acquire imaging data of the surgical site for presentation to asurgeon in which the presentation can include information related to thepresence of vascular structures located beneath the surface of asurgical site.

Some aspects of the present disclosure further provide for a controlcircuit configured to control the illumination of a surgical site usingone or more illumination sources such as laser light sources and toreceive imaging data from one or more image sensors. In some aspects,the present disclosure provides for a non-transitory computer readablemedium storing computer readable instructions that, when executed, causea device to detect a blood vessel in a tissue and determine its depthbelow the surface of the tissue.

In some aspects, a surgical image acquisition system may include aplurality of illumination sources wherein each illumination source isconfigured to emit light having a specified central wavelength, a lightsensor configured to receive a portion of the light reflected from atissue sample when illuminated by the one or more of the plurality ofillumination sources, and a computing system. The computing system maybe configured to: receive data from the light sensor when the tissuesample is illuminated by each of the plurality of illumination sources;determine a depth location of a structure within the tissue sample basedon the data received by the light sensor when the tissue sample isilluminated by each of the plurality of illumination sources, andcalculate visualization data regarding the structure and the depthlocation of the structure. In some aspects, the visualization data mayhave a data format that may be used by a display system, and thestructure may comprise one or more vascular tissues.

In an aspect, a surgical image acquisition system may include anindependent color cascade of illumination sources comprising visiblelight and light outside of the visible range to image one or moretissues within a surgical site at different times and at differentdepths. The surgical image acquisition system may further detect orcalculate characteristics of the light reflected and/or refracted fromthe surgical site. The characteristics of the light may be used toprovide a composite image of the tissue within the surgical site as wellas provide an analysis of underlying tissue not directly visible at thesurface of the surgical site. The surgical image acquisition system maydetermine tissue depth location without the need for separatemeasurement devices.

In an aspect, the characteristic of the light reflected and/or refractedfrom the surgical site may be an amount of absorbance of light at one ormore wavelengths. Various chemical components of individual tissues mayresult in specific patterns of light absorption that are wavelengthdependent.

In one aspect, the illumination sources may comprise a red laser sourceand a near infrared laser source, wherein the one or more tissues to beimaged may include vascular tissue such as veins or arteries. In someaspects, red laser sources (in the visible range) may be used to imagesome aspects of underlying vascular tissue based on spectroscopy in thevisible red range. In some non-limiting examples, a red laser lightsource may source illumination having a peak wavelength that may rangebetween 635 nm and 660 nm, inclusive. Non-limiting examples of a redlaser peak wavelength may include about 635 nm, about 640 nm, about 645nm, about 650 nm, about 655 nm, about 660 nm, or any value or range ofvalues therebetween. In some other aspects, near infrared laser sourcesmay be used to image underlying vascular tissue based on near infraredspectroscopy. In some non-limiting examples, a near infrared lasersource may emit illumination have a wavelength that may range between750-3000 nm, inclusive. Non-limiting examples of an infrared laser peakwavelength may include about 750 nm, about 1000 nm, about 1250 nm, about1500 nm, about 1750 nm, about 2000 nm, about 2250 nm, about 2500 nm,about 2750 nm, 3000 nm, or any value or range of values therebetween. Itmay be recognized that underlying vascular tissue may be probed using acombination of red and infrared spectroscopy. In some examples, vasculartissue may be probed using a red laser source having a peak wavelengthat about 660 nm and a near IR laser source having a peak wavelength atabout 750 nm or at about 850 nm.

Near infrared spectroscopy (NIRS) is a non-invasive technique thatallows determination of tissue oxygenation based on spectro-photometricquantitation of oxy- and deoxyhemoglobin within a tissue. In someaspects, NIRS can be used to image vascular tissue directly based on thedifference in illumination absorbance between the vascular tissue andnon-vascular tissue. Alternatively, vascular tissue can be indirectlyvisualized based on a difference of illumination absorbance of bloodflow in the tissue before and after the application of physiologicalinterventions, such as arterial and venous occlusions methods.

Instrumentation for near-IR (NIR) spectroscopy may be similar toinstruments for the UV-visible and mid-1R ranges. Such spectroscopicinstruments may include an illumination source, a detector, and adispersive element to select a specific near-IR wavelength forilluminating the tissue sample. In some aspects, the source may comprisean incandescent light source or a quartz halogen light source. In someaspects, the detector may comprise semiconductor (for example, anInGaAs) photodiode or photo array. In some aspects, the dispersiveelement may comprise a prism or, more commonly, a diffraction grating.Fourier transform NIR instruments using an interferometer are alsocommon, especially for wavelengths greater than about 1000 nm. Dependingon the sample, the spectrum can be measured in either reflection ortransmission mode.

FIG. 10 depicts schematically one example of instrumentation 2400similar to instruments for the UV-visible and mid-IR ranges for NIRspectroscopy. A light source 2402 may emit a broad spectral range ofillumination 2404 that may impinge upon a dispersive element 2406 (suchas a prism or a diffraction grating). The dispersive element 2406 mayoperate to select a narrow wavelength portion 2408 of the light emittedby the broad spectrum light source 2402, and the selected portion 2408of the light may illuminate the tissue 2410. The light reflected fromthe tissue 2412 may be directed to a detector 2416 (for example, bymeans of a dichroic mirror 2414) and the intensity of the reflectedlight 2412 may be recorded. The wavelength of the light illuminating thetissue 2410 may be selected by the dispersive element 2406. In someaspects, the tissue 2410 may be illuminated only by a single narrowwavelength portion 2408 selected by the dispersive element 2406 form thelight source 2402. In other aspects, the tissue 2410 may be scanned witha variety of narrow wavelength portions 2408 selected by the dispersiveelement 2406. In this manner, a spectroscopic analysis of the tissue2410 may be obtained over a range of NIR wavelengths.

FIG. 11 depict schematically one example of instrumentation 2430 fordetermining NIRS based on Fourier transform infrared imaging. In FIG. 11, a laser source emitting 2432 light in the near IR range 2434illuminates a tissue sample 2440. The light reflected 2436 by the tissue2440 is reflected by a mirror, such as a dichroic mirror 2444, to a beamsplitter 2446. The beam splitter 2446 directs one portion of the light2448 reflected by the tissue 2440 to a stationary mirror 2450 and oneportion of the light 2452 reflected 2436 by the tissue 2440 a movingmirror 2454. The moving mirror 2454 may oscillate in position based onan affixed piezoelectric transducer activated by a sinusoidal voltagehaving a voltage frequency. The position of the moving mirror 2454 inspace corresponds to the frequency of the sinusoidal activation voltageof the piezoelectric transducer. The light reflected from the movingmirror and the stationary mirror may be recombined 2458 at the beamsplitter 2446 and directed to a detector 2456. Computational componentsmay receive the signal output of the detector 2456 and perform a Fouriertransform (in time) of the received signal. Because the wavelength ofthe light received from the moving mirror 2454 varies in time withrespect to the wavelength of the light received from the stationarymirror 2450, the time-based Fourier transform of the recombined lightcorresponds to a wavelength-based Fourier transform of the recombinedlight 2458. In this manner, a wavelength-based spectrum of the lightreflected from the tissue 2440 may be determined and spectralcharacteristics of the light reflected 2436 from the tissue 2440 may beobtained. Changes in the absorbance of the illumination in spectralcomponents from the light reflected from the tissue 2440 may thusindicate the presence or absence of tissue having specific lightabsorbing properties (such as hemoglobin).

An alternative to near infrared light to determine hemoglobinoxygenation would be the use of monochromatic red light to determine thered light absorbance characteristics of hemoglobin. The absorbancecharacteristics of red light having a central wavelength of about 660 nmby the hemoglobin may indicate if the hemoglobin is oxygenated (arterialblood) or deoxygenated (venous blood).

In some alternative surgical procedures, contrasting agents can be usedto improve the data that is collected on oxygenation and tissue oxygenconsumption. In one non-limiting example, NIRS techniques may be used inconjunction with a bolus injection of a near-IR contrast agent such asindocyanine green (ICG) which has a peak absorbance at about 800 nm. ICGhas been used in some medical procedures to measure cerebral blood flow.

In one aspect, the characteristic of the light reflected and/orrefracted from the surgical site may be a Doppler shift of the lightwavelength from its illumination source.

Laser Doppler flowmetry may be used to visualize and characterized aflow of particles moving relative to an effectively stationarybackground. Thus, laser light scattered by moving particles, such asblood cells, may have a different wavelength than that of the originalilluminating laser source. In contrast, laser light scattered by theeffectively stationary background (for example, the vascular tissue) mayhave the same wavelength of that of the original illuminating lasersource. The change in wavelength of the scattered light from the bloodcells may reflect both the direction of the flow of the blood cellsrelative to the laser source as well as the blood cell velocity.

FIG. 12 depicts an aspect of instrumentation 2530 that may be used todetect a Doppler shift in laser light scattered from portions of atissue 2540. Light 2534 originating from a laser 2532 may pass through abeam splitter 2544. Some portion of the laser light 2536 may betransmitted by the beam splitter 2544 and may illuminate tissue 2540.Another portion of the laser light may be reflected 2546 by the beamsplitter 2544 to impinge on a detector 2550. The light back-scattered2542 by the tissue 2540 may be directed by the beam splitter 2544 andalso impinge on the detector 2550. The combination of the light 2534originating from the laser 2532 with the light back-scattered 2542 bythe tissue 2540 may result in an interference pattern detected by thedetector 2550. The interference pattern received by the detector 2550may include interference fringes resulting from the combination of thelight 2534 originating from the laser 2532 and the Doppler shifted (andthus wavelength shifted) light back-scattered 2452 from the tissue 2540.

It may be recognized that back-scattered light 2542 from the tissue 2540may also include back scattered light from boundary layers within thetissue 2540 and/or wavelength-specific light absorption by materialwithin the tissue 2540. As a result, the interference pattern observedat the detector 2550 may incorporate interference fringe features fromthese additional optical effects and may therefore confound thecalculation of the Doppler shift unless properly analyzed.

FIG. 13 depicts an aspect of a composite visual display 280 that may bepresented a surgeon during a surgical procedure. The composite visualdisplay 2800 may be constructed by overlaying a white light image 2830of the surgical site with a Doppler analysis image 2850.

The white light image 2830 may portray the surgical site 2832, one ormore surgical incisions 2834, and the tissue 2836 readily visible withinthe surgical incision 2834. The white light image 2830 may be generatedby illuminating 2840 the surgical site 2832 with a white light source2838 and receiving the reflected white light 2842 by an opticaldetector. Although a white light source 2838 may be used to illuminatethe surface of the surgical site, in one aspect, the surface of thesurgical site may be visualized using appropriate combinations of red2854, green 2856, and blue 2858 laser light.

The Doppler analysis image 2850 may include blood vessel depthinformation along with blood flow information 2852 (from speckleanalysis). Blood vessel depth and blood flow velocity may be obtained byilluminating the surgical site with laser light of multiple wavelengths,and determining the blood vessel depth and blood flow based on the knownpenetration depth of the light of a particular wavelength. In general,the surgical site 2832 may be illuminated by light emitted by one ormore lasers such as a red leaser 2854, a green laser 2856, and a bluelaser 2858. A CMOS detector 2872 may receive the light reflected back(2862, 2866, 2870) from the surgical site 2832 and its surroundingtissue. The Doppler analysis image 2850 may be constructed 2874 based onan analysis of the multiple pixel data from the CMOS detector 2872.

For example, a red laser 2854 may emit red laser illumination 2860 onthe surgical site 2832 and the reflected light 2862 may reveal surfaceor minimally subsurface structures. In one aspect, a green laser 2856may emit green laser illumination 2864 on the surgical site 2832 and thereflected light 2866 may reveal deeper subsurface characteristics. Inanother aspect, a blue laser 2858 may emit blue laser illumination 2868on the surgical site 2832 and the reflected light 2870 may reveal, forexample, blood flow within deeper vascular structures. The specklecontrast analysis my present the surgeon with information regarding theamount and velocity of blood flow through the deeper vascularstructures.

Although not depicted in FIG. 13 it may be understood that the imagingsystem may also illuminate the surgical site with light outside of thevisible range. Such light may include infra-red light and ultravioletlight. In some aspects, sources of the infra-red light or ultravioletlight may include broad-band wavelength sources (such as a tungstensource, a tungsten-halogen source, or a deuterium source). In some otheraspects, the sources of the infra-red or ultraviolet light may includenarrow-band wavelength sources (IR diode lasers, UV gas lasers or dyelasers).

The depth of a surface feature in a piece of tissue may be determined.An image acquisition system may illuminate a tissue with a first lightbeam having a first central frequency and receive a first reflectedlight from the tissue illuminated by the first light beam. The imageacquisition system may then calculate a first Doppler shift based on thefirst light beam and the first reflected light. The image acquisitionsystem may then illuminate the tissue with a second light beam having asecond central frequency and receive a second reflected light from thetissue illuminated by the second light beam. The image acquisitionsystem may then calculate a second Doppler shift based on the secondlight beam and the second reflected light. The image acquisition systemmay then calculate a depth of a tissue feature based at least in part onthe first central wavelength, the first Doppler shift, the secondcentral wavelength, and the second Doppler shift. The tissue featuresmay include the presence of moving particles, such as blood cells movingwithin a blood vessel, and a direction and velocity of flow of themoving particles. It may be understood that the method may be extendedto include illumination of the tissue by any one or more additionallight beams. Further, the system may calculate an image comprising acombination of an image of the tissue surface and an image of thestructure disposed within the tissue.

Multiple visual displays may be used. For example, a 3D display mayprovide a composite image displaying the combined white light (or anappropriate combination of red, green, and blue laser light) and laserDoppler image. Additional displays may provide only the white lightdisplay or a displaying showing a composite white light display and anNIRS display to visualize only the blood oxygenation response of thetissue. However, the NIRS display may not be required every cycleallowing for response of tissue.

A surgical visualization system using the imaging technologies disclosedherein may benefit from ultrahigh sampling and display frequencies.Sampling rates may be associated with the capabilities of the underlyingdevice performing the sampling. A general-purpose computing system withsoftware may be associated with a first range of achievable samplingrates. A pure-hardware implementation (e.g., a dedicated applicationspecific integrated circuit, ASIC) may be associated with a second rangeof achievable sampling rates. The second range, associated with thepure-hardware implementation, will generally be higher (e.g., muchhigher) than the first range, associated with general-purpose computingsoftware implementation.

A surgical visualization system using the imaging technologies disclosedherein may benefit from solutions that balance the higher samplingrates, associated with hardware-based implementations, with theadaptability and/or updatability of software systems. Such a surgicalvisualization systems may employ a mix of hardware and softwaresolutions. For example, a surgical visualization system may employvarious hardware-implemented transforms with a software selector. Asurgical visualization system may also employ a field programmable gatearray (FPGA). An FPGA may include a hardware device that may include oneor more logic elements. These logic elements may be configured by abitstream to implement various functions. For example, the logicelements may be configured to perform certain individual logic functionsand configured to perform them with a certain order and interconnection.Once configured, the FPGA may perform its function using the hardwarelogic elements without further configuration. Also once configured, theFPGA may be reconfigured with a different bitstream to implement adifferent function. And similarly, once reconfigured, the FPGA mayperform this different function using the hardware logic elements.

FIG. 14 illustrates an example surgical visualization system 10000. Thesurgical visualization system 10000 may be used to analyze at least aportion of a surgical field. For example, the surgical visualizationsystem 10000 may be used to analyze tissue 10002 within the at least aportion of the surgical field. The surgical visualization system 10000may include an FPGA 10004, a processor (for example, a processor 10006local to the FPGA 10004, a memory 10008, a laser-light illuminationsource 10010, a light sensor 10012, a display 10014, and/or a processor10016 remote to the FGPA. The surgical visualization system 10000 mayinclude components and functionality described in connection with FIGS.9A-C for example.

The system 1000 may use an FPGA 10004 to convert the reflected laserlight through a transform of frequency to identify a Doppler shift, forexample, of the light to determine moving particles. This transformeddata may be displayed (e.g., displayed in real-time). It may bedisplayed, for example, as a graphic and/or metric 10020, representingthe number of moving particles each second. The system 10000 may includecommunication between the processor 10006 local to the FPGA 10004 andthe processor 10016 remote to the FGPA. For example, the processor 10016remote to the FGPA 10004 may aggregate data (e.g., multiple seconds ofdata). And the system may be able to display that aggregation of data.For example, it may be displayed as a graphic and/or metric 10026representing a moving trend. This graphic and/or metric 10026 may besuperimposed on the real-time data. Such trend information may be usedto identify occlusions, instrument vascular sealing/clamping efficiency,vascular tree overviews, even oscillating magnitudes of motion overtime. The FPGA 10004 may be configured to be on-the-fly updateable, forexample, updatable with different (e.g., more sophisticated)transformations. These updates may come from local or remotecommunication servers. These updates may, for example, change thetransform's analysis from refractivity (e.g., analysis of cellularirregularities), to blood flow, to multiple simultaneous depth analysis,and the like.

The FPGA updates may include transforms that implement a variety ofimaging options for the user. These imaging options may include standardcombined visual light, tissue refractivity, doppler shift, motionartifact correction, improved dynamic range, improved local clarity,super resolution, NIR florescence, multi-spectral imaging, confocallaser endomicroscopy, optical coherence tomography, raman spectroscopy,photoacoustic imaging, or any combination. The imaging options mayinclude any of the options presented in any of the following: U.S.patent application Ser. No. 15/940,742, entitled “DUAL. CMOS ARRAYIMAGING,” filed Mar. 29, 2018; U.S. patent application Ser. No.13/952,564, entitled “WIDE DYNAMIC RANGE USING MONOCHROMATIC SENSOR,”FILED Jul. 26, 2013; U.S. patent application Ser. No. 14/214,311,entitled “SUPER RESOLUTION AND COLOR MOTION ARTIFACT CORRECTION IN APULSED COLOR IMAGING SYSTEM,” filed Mar. 14, 2014; U.S. patentapplication Ser. No. 13/952,550, entitled “CAMERA SYSTEM WITH MINIMALAREA MONOLITIC CMOS IMAGE SENSOR,” filed Jul. 26, 2013, each of which isincorporated herein by reference in its entirety. Doppler wavelengthshifting may be used to identify the number, size, speed, and/ordirectionality of moving particles, for example. Doppler wavelengthshifting may be used with multiple laser wavelengths to interrelate thetissue depth and moving particles, for example. Tissue refractivity maybe used for identification of irregular or variability of tissuesuperficial and sub-surface aspects, for example. In surgical practice,it may benefit identifying tumor margins, infection, broken surfacetissue, adhesions, changes in tissue composition, and the like. NIRFluorescence may include techniques in which systemically-injected drugsare preferentially absorbed by targeted tissue. When illuminated withthe appropriate wavelength of light, they fluoresce and can be imagedthrough a NIR-capable scope/camera. Hyperspectral imaging and/ormultispectral imaging may include the illumination and assessment oftissue across many wavelengths throughout the electromagnetic spectrumto provide real-time images. It may be used to differentiate betweentarget tissues. It may also enable an imaging depth of 0-10 mm forexample. Confocal laser endomicroscopy (CLE) may uses light to capturehigh-resolution, cellular level resolution without penetrating intotissue. It may provide a real-time histopathology of tissue. Technologythat uses light to capture micrometer-resolution, 3D images from withintissues. Optical coherence tomography (OCT) may employ NIR light. OCTmay enable imaging of tissue at depths of 1-2 mm, for example. Ramanspectroscopy may include techniques that measure photon shifts caused bymonochromatic laser illumination of tissue. It may be used to identifycertain molecules. Photoacoustic imaging may include subjecting tissueto laser pulses such that a portion of the energy causes thermoelasticexpansion and ultrasonic emission. These resulting ultrasonic waves maybe detected and analyzed to form images.

The laser-light illumination source 10010 may include any illuminationsource of laser light suitable for analyzing human tissue. Thelaser-light illumination source 10010 may include a device such as thesource laser emitters. The laser light illumination source 10010 may useone or more wavelengths of laser light to illuminate the tissue 10002.For example, the laser-light illumination source 10010 may use ared-blue-green-ultraviolet 1-ultraviolet 2-infrared combination. Thiscombination with a 360-4801 Hz sampling and actuation rate, for example,would allow for each light source to have multiple frames at an end user60 Hz combined frame rate. A laser light wavelength combination withindependent sources may increase resolution from a single array and mayenable various depth penetration.

The tissue 10002 may be human tissue within a portion of a surgicalfield, for example. The laser light may reflect from the tissue 10002,resulting in reflected laser light. The reflected laser light may bereceived by the light sensor 10012. The light sensor 10012 may beconfigured to receive reflected laser light from a least a portion ofthe surgical field. The light sensor 10012 may be configured to receivelaser light from the entirety of the surgical field. The light sensormay be configured to receive reflected laser light from a selectableportion of the surgical field. For example, a user, such as a surgeon,may direct the light sensor and the light laser light illuminationsource and/or the laser light illumination source to analyze specificportions of the surgical field.

The light sensor 10012 may be any device suitable for sensing reflectedlaser light and outputting corresponding information. For example, thelight sensor 10012 may detect one or more characteristics of thereflected laser light, such as amplitude, frequency, wavelength, dopplershift, and/or other time domain or frequency domain qualities, forexample. The laser-light sensor 10012 source may include a device suchas the light sensor disclosed in connection with FIGS. 9A-C for example.

The laser-light sensor 10012 may include one or more sensor modules10013. The sensor modules 10013 may be configured to measure a widerange of wavelengths. The sensor modules 10013 may be tuned and/orfiltered to measure specific wavelengths for example. The sensor modules10013 may include discrete sensors, a collection of sensors, a sensorarray, a combination of sensor arrays, or the like, for example. Forexample, the sensor modules 10013 may include semiconductor componentssuch as photodiodes, CMOS (complementary metal oxide semiconductor)image sensors, CCD (charge coupled device) image sensors, or the like.The laser-light sensor 10012 may include a dual CMOS arrays. Details onusing FPGA in imaging system can be found in U.S. patent applicationSer. No. 17/062,521 (Attorney Docket No. END9287USNP2), entitledTIERED-ACCESS SURGICAL VISUALIZATION SYSTEM, filed Oct. 2, 2020, whichis herein incorporated by reference in its entirety.

FIG. 15 illustrates an example aspect of the visualization systemdescribed herein. Example surgical visualization system 45500 may beused to analyze tissue 10002 within the at least a portion of thesurgical field. The surgical visualization system 45500 may includelaser-light illumination source(s) 10010, light sensor(s) 10012,display(s) 10014, and/or one or more processing units 45502 and 45504.The surgical visualization system 45500 may include components andfunctionality described in connection with FIG. 14 for example, such aslaser-light illumination source(s) 10010, light sensor(s) 10012including sensor module(s) 10013, and/or display(s) 10014. The surgicalvisualization system 45500 may include components and functionalitydescribed in connection with FIGS. 9A-C for example.

As shown in FIG. 15 , one or more surgical video streams generated fromlight sensors(s) 10012 may be transmitted via pathway 45506, pathway45508, pathway 45510 and/or other pathways to display(s) 10014. Thesurgical video streams may include various video feeds described hereinwith reference to FIGS. 9-14 . The surgical video streams may include aprimary visual video feed, such as an intra-body camera feed. Thesurgical video streams may include one or more secondary surgical videofeeds such as video streams associated with multispectral analysis,video streams associated with Doppler flowmetry, video streams ofdifferent spectral ranges, video streams captured using visible lightand light outside of the visible range, video streams captured atdifferent time intervals, and/or video stream(s) for overlaying ontoanother video stream.

The surgical video stream(s) may be processed via one or more processingmodules. For example, video stream 45514 may be processed via processingmodule(s) 45502, and the video stream 45516 may be processed viaprocessing module(s) 45504. The video streams may be multiple feeds ofthe same source stream being communicated and processed separately. Asshown, video stream 45512 may be transmitted via a dedicatedcommunication pipeline, bypassing processing modules, such as processingmodules 45502 and 45504. For example, video stream 45512 may be an HDvideo feed with no processing or intermediate steps between scope anddisplay. The video streams 45514 and 45516 may be sent through postcapture processing to extract or convert the video or image(s) to supplyother visualization capabilities. Video stream 45512 may be the same asthe video streams 45514 and/or 45516 prior to processing via processingmodule(s) 45502 and/or 45504. Processing 45502 and 45504 can be the sameor different.

As shown in FIG. 15 , redundant surgical imaging communication pipe waysand processing may provide a fail-safe condition for the primary visuallight feed. The primary video stream may be transmitted via multiplepathways. For example, the video stream may be divided into differentportions for transmission via multiple pathways. A portion of the videostream, for example, every other picture frame, may be transmitted via apathway, and the rest of the video stream or the remaining pictureframes may be transmitted via another pathway. The two portions may becombined or merged prior to display. Thus, transmission speed of thevideo feed may be increased and may overcome the data storage andtransport limits of the system architecture. For example, the two videostream portions may be encoded such that they may be independentlydecoded and displayed without being re-combined. Combining the twoportions may result in a higher quality video feed; however, displayinga video stream portion may provide sufficient view of the surgical sitefor a surgeon. If an issue associated with a pathway for transmitting aportion of the video stream is detected, combining or merging of thevideo stream portions may be suspended, and the video stream portionthat has successfully been transmitted to the display system may bedisplayed.

The primary video stream may be processed via multiple instances of thesame processing module(s) through different pathways. If an instance ofthe processing modules experience latency or failure, the video streammay be processed via another instance of the processing modules may bedisplayed. If processing causes undue latency or experiences failure,the video stream that bypasses processing may be displayed. Utilizingmultiple video stream paths may improve processing speed andreliability, as an individual pathway may be associated with isolatedindividual processing elements. By performing processing tasks inparallel, the failure of one video feed may not result in the loss ofall feeds. Performing different processing tasks in parallel and combinethe processed video streams for display may increase processingthroughput and reduce latency.

For example, the computing system may control the capturing, processing,and/or communication of the visualization feed(s) to prioritize latencyover reliability, or prioritize reliability over latency. The priorityfocus may be controlled or updated dynamically. For example, thecomputing system may prioritize within the FPGAs such that latency maybe reduced. The visualization feed(s) may be prioritized within theFPGAs such that the reliability of the video stream may be improved. Forexample, the computing system may adjust the communication paths such ascommunication paths 45506, 45508 and 45510 to prioritize latency overreliability, or prioritize reliability over latency. For example,allocating more communication pathways to transmit the same video streammay increase reliability, and allocating communication pathways forparallel processing may reduce latency.

Thus, the redundancy allows for the advanced computational imagingprocessing, reduced latency, and/or allow a communication to fail whilestill providing an assured visual feed of the camera.

FIG. 16 illustrates example process for using redundant pipe ways forcommunicating surgical imaging feed(s). At 45520, multiple surgicalvideo streams may be obtained via multiple pathways. The multiple videoor imaging feeds could be copies of the same feed with differentpathways to the user display. For example, a first video stream may beobtained via a communication pathway, and a second video stream may beobtained via another communication pathway. The multiple surgical videostreams could be bifurcated allowing a portion of the feed to pass downone path and a different portion to pass through another pathway. Forexample, a surgical video stream may be an HD video feed, and a surgicalvideo stream may be of a higher quality video stream or a video streamwith added visualization capabilities. The multiple surgical videostreams may be obtained from the same intra-body visual light feed, ormay be obtained from different intra-body visual light feeds. At 45522,a video stream may be displayed. At 45524, whether the video streambeing displayed has encountered at least one issue may be determined.Upon detecting an issue with the video stream being displayed, at 45526,another video stream may be displayed. For example, the primary videostream may be displayed initially. Upon detecting an issue associatedwith the primary video, the secondary video stream may be displayed. Theredundant communication pathways may be used in parallel to improvereliability, communication speed, throughput, and/or to reduce latencyof surgical imaging/video feeds for display.

FIG. 17 illustrates example process for using redundant processing pathsfor processing surgical imaging feed(s). At 45530, a source surgicalimaging stream may be obtained. For example, the source surgical imagingstream may be obtained as described herein with reference to FIGS. 9-15. At 45532, the source stream may be processed using multiple processingmodules. For example, at least some processing modules may be used toprocess the surgical imaging stream in parallel. At 45534, whether anissue has been encountered at a processing module may be determined. Ifno issue has been found, the processed video streams may be merged fordisplay at 45536. Upon detecting an issue associated with a processingmodule, at 45540, a video stream unaffected by the detected issue may bedisplayed. For example, a video stream that has not been processed bythe processing module associated with the detected issue may be selectedfor display.

For example, surgical imaging stream generated from light sensors(s)10012 as shown in FIG. 15 may be obtained. The source surgical imagingstream may be processed using processing module(s) 45502 and processingmodule(s) 45504 in parallel. The processing module(s) 45502 and theprocessing module(s) 45504 may be different instances of the same typeof processing modules. The processed video stream 45514 and theprocessed video stream 45516 may be merged for display.

Upon detecting an issue associated with processing module(s) 45504, theprocessed video stream 45516 may become unavailable, and merging of theprocessed video streams 45514 and 45516 may be stopped. The processedvideo stream 45514 may identified as a video stream unaffected by thedetected issue and may be displayed. The video stream 45512 shown inFIG. 15 , which bypasses the processing modules, may be identified as avideo stream unaffected by the detected issue and may be displayed. Forexample, the unprocessed video stream may be selected for display whenboth processing module(s) 45502 and 45504 encounter issues. For example,the computing system may detect an issue associated with a processingmodule and provide an indication of the processing interruption. Thecomputing system may provide an option to an HCP to enable the HCP tomanually control the visualization system. The computing system mayallow the user to select bypassing processing aspects of thevisualization system. Thus, computing system may ensure that the usercan display the video even if the hardware processing fails. Theprocessing module(s) 45502 and the processing module(s) 45504 may beused in parallel to improve processing throughput, reduce latency,and/or to guarantee the availability of surgical imaging stream fordisplay.

For example, a source video stream, such as a video stream generatedfrom light sensors(s) 10012 as shown in FIG. 15 may be divided intodifferent portions to be processed separately. A portion of the videostream, for example, every other picture frame, may be processed using afirst processing module such as processing module(s) 45502, and the restof the video stream or the remaining picture frames may be processedusing a second processing module such as processing module(s) 45504. Thetwo processed video portions, such as processed video streams 45514 and45516 may be combined or merged prior to display. Thus, processing speedof the video feed may be increased and may overcome the processinglimits of the system architecture. Combining the two portions may resultin a higher quality video feed; however, displaying a video streamportion may provide sufficient view of the surgical site for a surgeon.If an issue associated with a processing module is detected, combiningor merging of the video stream portions may be suspended, and the videostream portion that has successfully been processed may be displayed.

For example, multiple source video streams may be generated from lightsensors(s) 10012 as shown in FIG. 15 . The source video streams maycontain images associated with different temporal aspects. The videostreams, for example, after processing, may be merged for display. Thevideo streams may be displayed on their own, without merging. Forexample, a video stream may serve as a redundant backup supply to ensurethe user has display of the source despite of an issue with a processingmodule or a communication pathway.

Example processing modules may include, but not limited to,multispectral analysis module as described herein with reference to FIG.14 , Laser Doppler flowmetry analysis module as described herein withreference to FIGS. 12 and 13 , field programmable arrays, a contentcomposite module, and/or the like.

An example processing module may be configured to enhance a surgicalvideo stream using another video stream. For example, the computingsystem may derive contextual information associated with the surgery byanalyzing a video stream described herein. The contextual informationmay be used to enhance another surgical video stream. For example, thecomputing system may extract one or more portions (e.g., a portion thatincludes an area of interest) from a surgical video stream and overlaythe extracted portion onto another surgical video stream, as describedherein.

An example processing module may be configured to annotate the surgicalvideo. As those skilled in the art may appreciate, a video may beannotated with metadata. Visual annotation may include denotinglocations of object or people of interest in the video, describingobjects in the video, describing the context of the scene, and/orproviding other information. For example, the processing module may beconfigured to annotate the microsurgical outcomes. The processing modulemay be configured to analyze the video feed and identify the point(s) intime to add label(s). The processing module may receive data fromsurgical device(s) and may be configured to annotate data captured viadevice sensor(s), such as raw sensor data. The processing module may beconfigured to annotate scaling. The processing module may be configuredto convert the video stream for use with a 3D environmentalvisualization tool. The annotations may be inserted on time stamp or onthe video itself. The processing module may receive input from HCPs,such as resident diaries. The raw sensor data may be coupled withresident diaries when annotated into the surgical video. The videostream for use with a 3D environmental visualization tool may beannotated with resident diaries. The processing module may be configuredto track an object of interest and identify the object's contour when itis obstructed or partially obstructed. The processing module mayannotate the contour of the object of interest in the video. Theprocessing module may receive surgical information such as contextualinformation from the situationally aware surgical hub as describedherein with reference to FIG. 8 and may insert the contextualinformation into the video. The processing module may be configured toannotate of a process of multiple events through time.

An example processing module may be configured to derive contextualinformation associated with a surgery by analyzing a video streamdescribed herein. The derived contextual information may be indicated in(e.g., inserted into) another video stream. For example, as describedherein, the derived contextual information may be inserted into anoverlay region described herein.

Objects may be recognized and tracked via video processing from videocaptured by one or more imaging systems. The video may be analyzed toidentify objects. For example, a processing module may identify andhighlight known objects via annotation, such that the recognized objectmay be recognizable with frame-to-frame outlining. The processing modulemay localize one or more objects of interest in the video. For example,the processing module may predict an object in an image within aboundary. Various known image or video processing technologies, such askeypoint detection and analysis, bounding box annotation, polygon meshprocessing, image segmentation, facial recognition, gesture recognition,point cloud, lines and splines, and/or the like may be used to analyzethe video feeds. Those skilled in the art may appreciate that variousobject detection and tracking technologies used in autonomous vehiclemay be used in surgical video processing.

The video may be processed to identify the motion of HCP(s) and/orobject(s). Based on the motion information, the surgical activitiesand/or actions of the HCP(s) may be determined. For example, the HCPs orobjects may be tracked and categorized based on motion, function, and/ormanipulation. Repeatable pattern of events may be identified.

Video may be stored during processing, as a part of the display of thevideo. The computing system may be configured to erase the video afterprocessing and transferring the video, to address privacy concerns andretention aspects of in-process video.

A computing system may generate a composite video stream from multipleinput feeds. The computing system may obtain a surgical video stream andoverlay content associated with a surgical procedure. The computingsystem may determine the overlay region location for overlaying theoverlay content by analyzing the content of surgical video stream. Forexample, based on the content of a frame of the surgical video stream,the computing system may determine an overlay region location in theframe for overlaying the overlay content; based on the content of asubsequent frame of the surgical video stream, the computing system maydetermine another overlay region location in the subsequent frame foroverlaying the overlay content. The composite video stream may begenerated based on the overlay region locations determined for differentframes of the surgical video stream.

For example, the surgical video stream may be a video feed of thesurgical site from a laparoscopic scope, and the composite video streammay be generated by overlaying the overlay content onto the video of thesurgical site at the determined overlay region location. The location,orientation, and/or size of the overlay content may be adjusted on thesurgical site in the video stream as the laparoscopic scope moves. Thesurgical video stream may include frames having a surgical instrument,and the composite video stream may be generated by overlaying theoverlay content onto the surgical instrument at the determined overlayregion location. The location, orientation, and/or size of the overlaycontent may be adjusted in the video stream as the surgical instrumentmoves.

For example, the primary imaging of the surgical site may besupplemented by overlaying or inserting secondary video feed(s) and/ordata overlays. The overlay content may adjust as the primary scope imagemoves and may be oriented with respect to the surgical site and thesurgical instrument(s). The overlay content may cover the entire primaryimaging or may cover a portion of the primary imaging feed. The overlayregion may coincide with a predefined location on an instrument based onone or more fiducial marker(s) on the instrument.

FIG. 18 illustrates an example process for generating a compositesurgical video stream from multiple input feeds. At 45550, a surgicalvideo stream may be obtained. For example, the computing system mayobtain the surgical video stream via an imaging device such as theimaging device 20030 described herein with respect to FIG. 2 . Forexample, the computing system may obtain the surgical video stream asdescribed herein with reference to FIGS. 9-15 . The surgical videostream may be or may include a video feed of the surgical site from alaparoscopic scope. For example, the computing system may obtain thesurgical video stream via one or more cameras in the OR, such as cameras20021 as described herein with reference to FIG. 2 .

At 45552, overlay content may be obtained. Overlay content may includeinformation associated with a device such as a surgical instrument. Forexample, overlay content for overlaying onto an energy device in animage or video may include an indication of the energy bladetemperature, an indication of the energized state (e.g., due tocapacitive coupling), and/or other information associated with theenergy device. For example, the overlay content may includesteps-for-use instructions associated with a surgical instrument. Forexample, overlay content for overlaying onto a surgical stapling andcutting device the m an image or video may include an indication of theloading condition of the surgical instrument (e.g., whether a cartridgeis loaded). The loading condition on the surgical instrument may besensed, and the overlay content may be generated based on the sensedloading condition. This may prevent a knife blade from moving forwardwhen cartridge is not loaded, or improperly loaded.

The overlay content can include a label for the anatomical section and aperipheral margin of at least a portion of the anatomical section. Theperipheral margin can be configured to guide a surgeon to a cuttinglocation relative to the anatomical section. The overlay content mayinclude a supplementary image of an organ associated with the surgicalprocedure. The overlay content may include alternative imaging. Theoverlay content may include one or more of data obtained via pre-surgerytumor MRI, CT imaging, relevant pre-surgery data, ICG data, real-timedoppler monitoring, procedural steps, device status, and/or otheroverlays customizable by the users. The overlay content may include anindication associated with previous procedure steps of the surgery, suchas previous stapling(s) and/or previous weld(s).

Overlay content may include a secondary video feed or a portion of asecondary video feed. For example, the secondary video feed may be avideo feed that has been processed via one or more processing modules asdescribed herein with respect to FIG. 15 . The secondary video feed maybe a video associated with the current surgical procedure. The secondaryvideo feed may be a tutorial video showing how to carry out theprocedural steps. The secondary video feed may be a surgical simulationvideo. The secondary video feed may be a video of previous proceduresteps. For example, the secondary video feed may be a video of previousstapling(s) and/or previous weld(s). This may enable the HCP to compareprevious work with the current procedural step, for example, to identifythe transection site more readily. The computing system may extract aportion of the secondary surgical video feed as the overlay content. Forexample, the portion of the secondary surgical video that includes aregion of interest may be identified and extracted.

For example, the overlay content may be obtained from another videofeed, a surgical hub described herein, from one or more surgical devicesdescribed herein, and/or from one or more sensors described herein. Theoverlay content may be updated in real time, in response to a change ina location and/or orientation of the surgical instrument within thesurgical instrument frame. Various overlay content and obtaining theoverlay content is further described in U.S. patent application Ser. No.17/062,509 (Atty Docket: END9287USNP16 titled INTERACTIVE INFORMATIONOVERLAY ON MULTIPLE SURGICAL DISPLAYS, filed Oct. 2, 2020, which isincorporated by reference herein in its entirety.

At 45554, the location, size and/or orientation of the overlay regionmay be determined. The computing system may determine the overlay regionlocation for overlaying the overlay content by analyzing the content ofsurgical video stream. In examples, in-image markings may be used forinsertion of data, images, and alternative imaging streams. By trackingand reading markers on instrument, the computing system may overlayinformation at a consistent location relative to the instrument suchthat the overlay content may move as the instrument moves in the videofeed.

One or more overlay region(s) may be determined based on one or morefiducial marker(s). For example, a surgical instrument, such as thesurgical instrument described herein with reference to FIG. 7 , mayinclude one or more fiducial markers. The fiducial markers may be placedat predetermined location(s) on the surgical instrument. The locationsfor placing fiducial markers may include an area on the surgicalinstrument suitable for overlaying overlay content. The locations forplacing fiducial markers may include an area suitable for gauging theorientation of the surgical instrument and/or the distance of theinstrument to the imaging system (e.g., a camera). The fiducial markersmay be visible or invisible to human eyes, but recognizable via videoprocessing. The fiducial markers may be of specific shapes, such thatthe computing system may identify the surgical instrument based on thefiducial marker(s).

The fiducial markers may be in a predefined pattern such that thecomputing system may identify the surgical instrument based on thefiducial marker. For example, the fiducial marker may include anelectronic-readable code, such as QR code. The computing system mayobtain a video feed that captures the fiducial marker and identify thesurgical instrument based on the electronic-readable code (e.g.,captured in a video feed or imaging feed). Based on theelectronic-readable code, the computing system may retrieve informationassociated with the surgical instrument, such as the model of thesurgical instrument. For example, using the electronic-readable code,the computing system may obtain the spatial property informationassociated with the fiducial marker(s) on the surgical instrument. Thecomputing system may scale the overlay content based on the obtainspatial property of the marker(s) and the marker(s) in the video/imagingfeed.

The size of the overlay region may be determined based on the size of anarea on the surgical instrument suitable for content overlay, the sizeof a fiducial marker in real life, and the size of the fiducial markerin a video frame of the surgical video stream (e.g., a ratio between thereal-life size and the imaged size). For example, the computing systemmay identify the fiducial marker in the video frames of the surgicalvideo stream and determine the respective location, size, and/ororientation of the fiducial marker(s) in respective video frames. For agiven video frame, or a group of video frames, the computing system maydetermine the size, location and/or orientation of the overlay regionbased on the location, size and/or orientation of the fiducial markercaptured therein.

Details on fiducial markers and spatial awareness of surgical productsand instruments can be found in application entitled HUB IDENTIFICATIONAND TRACKING OF OBJECTS AND PERSONNEL WITHIN THE OR TO OVERLAY DATA THATIS CUSTOM TO THE USER'S NEED, attorney docket number END9340USNP15,filed contemporaneously, the contents of which are incorporated byreference herein.

As described herein, the overlay content may include an indication ofprevious stapling(s) or previous weld(s). The overlay content mayinclude alternative imaging such as CT image indicating the tumor. Theoverlay region may be determined such that the overlay content may beinserted next to but not interfering with the current jaw placements.This may enable the user to compare previous work with the currentand/or view the alterative imaging within the jaws to identify the tumorand/or transection site more readily.

At 45556, a composite video stream may be generated by overlaying theoverlay content onto the surgical video stream. A composite video streammay be generated, for example, by inserting the overlay content into thesurgical video stream, such as a primary surgical video feed. Forexample, overlay content may be scaled, oriented and inserted onto theshaft of a surgical instrument, based on the fiducial marker(s) capturedin the primary video. The location, size, shape and/or orientation ofthe overlay region may be adjusted dynamically, for example, as thesurgical device of interest moves in the primary video. For example,when the overlay content includes a secondary video feed or a portion ofa secondary video feed, the composite video may be generated using“picture-in-picture” techniques. The computing system may determine afirst overlay region size for overlaying the overlay content onto thefirst surgical video frame based on content of the first frame, and asecond overlay region size for overlaying the overlay content onto asecond surgical overlay frame based on content of the second frame. Thecomputing system may scale the secondary surgical video stream, or aportion of the secondary video stream that contains the region ofinterest based on the determined first overlay region size and thedetermined second overlay region size.

FIG. 18B shows an example process for generating a composite surgicalvideo stream using a fiducial marker. At 45553, a surgical video streammay be obtained, for example, as described herein. At 45555, a fiducialmarker may be identified in a video frame of the surgical video stream.At 45557, the overlay region location, orientation and/or size may beidentified for inserting overlay content into the video frame. At 45559,the overlay content may be inserted into the overlay region. The processmay be repeated for each frame, every other frame, every n frames,periodically, or aperiodically. For the example, the overlay regionlocation, orientation and/or size may be updated upon determining thatthe content of the primary stream changes (e.g., the location of thesurgical instrument changes significantly, the orientation of thesurgical instrument changes significantly). For example, the fiducialmarker may be placed on a surgical instrument. By identifying thefiducial marker in the video frames and using the identified fiducialmarker to determine the overlay region, the overlay content may move inthe composite video stream as the surgical instrument moves in thesurgical video stream.

FIGS. 19A-C illustrate example video frames of a composite surgicalvideo stream with overlay content that moves as a surgical instrument inthe surgical video stream moves. As described herein, a compositesurgical video stream may be generated by inserting overlay content intoa surgical video feed at one or more determined overlay regions. Thecomposite surgical video stream may include video frames with overlaycontent, which may be adjusted based on the content of correspondingframe from the surgical video feed. FIG. 19A shows an example videoframe 45560 of an example composite surgical video stream. As shown,video frame 45560 may include an image of a surgical instrument 45562,such as the surgical instrument 20282 described herein with respect toFIG. 7 . The overlay content 45564 may indicate the loading condition ofthe surgical instrument 45562, such as “unloaded,” as shown in FIG. 19A.The overlay region for inserting the overlay content 45564 may bedetermined based on the fiducial marker 45566 on the surgical instrument45562.

For example, the computing system may identify the location, size and/ororientation of the fiducial marker 45566 in a primary video frame of theprimary video feed. Based on the location, size and/or orientation ofthe fiducial marker 45566 in the primary video frame, the computingsystem may determine the location, size and/or orientation of theoverlay region, as described herein. As shown in FIG. 19A, the overlayregion may be identified such that the overlay content is easy to readand proportional to the surgical instrument.

FIG. 19B shows an example video frame 45570 of an example compositesurgical video stream. As shown in FIG. 19B, the overlay content 45574may reflect an updated loading condition of the surgical instrument45562, “loaded.” The surgical instrument 45562 and the fiducial marker45566 shown in video frame 45570 have moved compared to surgicalinstrument 45562 and the fiducial marker 45566 shown in video frame45560. Based on the location of the fiducial marker 45566, the computingdevice may determine the location of the overlay content region foroverlay content 45574. The surgical instrument 45562 and the fiducialmarker 45566 shown in video frame 45570 is smaller compared to surgicalinstrument 45562 and the fiducial marker 45566 shown in video frame45560. Based on the size of the fiducial marker 45566, the computingdevice may determine the size of the overlay content region for overlaycontent 45574. As shown in FIG. 19B, the overlay content 45574 is scaleddown from the overlay content 45564 shown in FIG. 19A. The surgicalinstrument 45562 and the fiducial marker 45566 shown in video frame45570 is in an “upside down” orientation compared to surgical instrument45562 shown in video frame 45560. Based on the orientation of thefiducial marker 45566, the computing device may determine theorientation of the overlay content region for overlay content 45574. Asshown in FIG. 19B, the overlay content 45574 is upside down as well.FIG. 19C shown an example video frame 45580 of an example compositesurgical video stream. As shown, the overlay content 45584 may be movedand scaled based on the fiducial marker 45566 but may be kept in uprightor substantially upright orientation to improve readability.

For example, de-identification may be performed for the video feed(s)described therein. De-identification process may be performed at theedge computing system, described herein with reference to FIG. 1B. Forexample, faces captures in the video feed(s) may be detected and blurredby the computing system. Face, silhouette, gait, and/or othercharacteristics may be obscured. Other person-identifying content, suchas ID badges, may be detected, blurred and/or removed from the video. Insome instances, a laparoscopic video, which usually contains in-bodyimaging may accidentally include out-of-body images. Such images may bedetected by the computing system may be removed from the video.

For example, video(s) obtained via in-room cameras may be correlatedwith video(s) obtained via in-body cameras to identify proceduralprogression information. The computing system may determine the surgicaltask being carried out based on the video frames obtained via intra-bodyscope in conjunction with the video frames obtained via OR camera(s).The determination may be further based on one or more monitoring sensorsdescribed herein with reference to FIGS. 1-8 . The computing system mayidentify an HCP (e.g., the HCP's role, present and/or pending task,and/or profession) based on the video frames obtained via intra-bodyscope and the video frames obtained via OR camera(s). Based on thedetermined procedural progression information and the identification ofthe HCP, the computing system may generate customized overlay contentfor the HCP. For example, the customized overlay content may bedisplayed via an augmented reality (AR) or mixed reality overlay on auser interface. The AR device may provide AR content to the HCP. Forexample, a visual AR device, such as safety glasses with an AR display,AR goggles, or head-mounted display (HMD), may include a graphicsprocessor for rendering 2D or 3D video and/imaging for display. Based onthe determined procedural progression information and the identificationof the HCP, the computing system may generate a customized controlsignal to an equipment or a surgical device. For example, based on adetermination that the HCP carrying an energy device is a nurse, thecomputing system may generate a control signal to prevent the energydevice from entering the energized state. For example, based on adetermination that the HCP carrying an energy device is a surgeon, thecomputing system may generate a control signal to allow the energydevice to enter an energized state.

For example, 3D modeling may be performed by combining imaging video(s),pre-surgical imaging, and/or intraoperative imaging. For example, thecomputing system may analyze video frames of a primary surgical imagingor video feed to identify missing information for the primary surgicalimaging or video feed. The computing system may identify region(s) ofpoor quality (e.g., artifacts, blurry, obstructed view, etc.) and mayprovide an indication to request additional imaging to supplement theprimary surgical video feed.

The computing system may identify region(s) associated with incompleteor missing information in the surgical imaging or video feed based onthe clarity of the region(s). The computing system may generate anotification indicating the identified region(s) associated withincomplete or missing information. For example, the notification mayinclude an indication of the surgical imaging or video frame with theidentified regions highlighted in a rendered shape and color. Thecomputing system may interpolate the likely location and shape of theorgan in the imaging or video frame.

The computing system may identify region(s) associated with potentiallymisleading data in the surgical imaging or video feed based on theclarity of the region(s). For example, region(s) with artifacts ordefects exceeding a threshold value may be identified. The computingsystem may generate a notification indicating that the surgical imagingor video feed contains potentially misleading information. For example,the notification may include an indication of the surgical imaging orvideo frame with the identified regions marked as containing potentiallymisleading information.

The computing system may generate an indication with instructionalinformation such as steps-for-use of what regions of the patient haveinconclusive or insufficient imaging. The computing system may indicateinformation associated with access port(s) for input of the additionalscan(s). The supplemental scan may be a different type ofimaging/scanning from the primary image source. For example, a CT scanof the abdomen could have insufficient or inconclusive data for theinside of the liver, pancreas, or other solid organ. The computingsystem may provide an indication or notification of a means for scanningwith an ultrasound imaging system. The computing system may obtain theimaging data from the supplemental scan and may combine the imaging dataobtained from the primary imaging source with the imaging data obtainedfrom the supplemental scan.

The computing system may fuse imagining data or videos obtained fromdifferent sources based on common anatomic landmarks. For example, thecomputing system may use the primary imaging as a source map for thesupplementary image. The computing system, by analyzing the primaryimaging, may identify the locations of content boundaries or borders,where the imaging data obtained from different sources may merge. Forexample, the computing system may use a third imaging source, such asimaging obtained via a laparoscope to identify linkable aspects forfusing the primary and secondary imaging data. For example, thecomputing system may fuse the primary and seconding imaging data basedon preset imaging fiducial markers.

After performing imaging data fusing, the computing system may determinea completeness level of organ imaging for one or more portion of thefused imaging. The completeness level for a portion of the fused imagingmay indicate an estimated completeness and/or accuracy of that portionof the fused image. In examples, the imaging data (e.g., still and/orvideo imaging data) may be generated via different energy imagingtechnologies. The completeness level of fused organ imaging may bedetermined based on the different energy imaging technologies.

The computing system may generate composite imaging data based onpartial imaging data from multiple imaging feeds. The multiple imagingfeeds may be received simultaneously. The composite imaging data may begenerated in real-time. For example, one or more portion of thecomposite imaging data may include visual light imaging, while otherportion(s) of the compositing imaging may include alternative sourceimaging as described herein. The computing system may generate thecomposite imaging data by replacing a portion of imaging data from oneimaging feed with a corresponding portion of the imaging data fromanother imaging feed. The computing system may overlay a portion ofimaging data from one imaging feed onto a corresponding portion of theimaging data from another imaging feed. The computing system mayhighlight (e.g., transparent highlight) a portion of imaging data fromone imaging feed based on a corresponding portion of the imaging datafrom another imaging feed.

For example, one or more portion of a surgical video stream may bedefined for expanded imaging overlay. The portions for expanding imagingoverlay may be pre-defined or determined based on a surgeon's inputduring a surgical procedure. The portion(s) for expanded imaging overlaymay include, but not limited to, a transection site, or a dissectionsite. The expanded imaging may include visualization of criticalstructure(s), blood supplies surrounding the transection site or thedissection site. For example, CT imaging may be superimposed on asurgical video stream (e.g., in a semi-transparent fashion). Theexpanded imaging overlay may enable a surgeon to select a transection ordissection path without damaging critical structure(s) of the patient'sorgan. The expanded imaging overlay may enable a surgeon todifferentiate the vascular tree supplies blood to a tumor from bloodvessels that do not supply blood to the tumor, and identify the bloodvessels to be severed. Details on overlaying content on a video feed ofa surgical site is further described in U.S. patent application Ser. No.17/062,509 (Atty Docket: END9287USNP16 titled INTERACTIVE INFORMATIONOVERLAY ON MULTIPLE SURGICAL DISPLAYS, filed Oct. 2, 20201, which isincorporated by reference herein in its entirety.

1. A computing system comprising: a processor configured to: obtain asurgical video stream associated with a surgical procedure; obtainoverlay content associated with the surgical procedure; determine afirst overlay region location in a first frame of the surgical videostream for overlaying the overlay content based on content of the firstframe of the surgical video stream; determine a second overlay regionlocation in a second frame of the surgical video stream for overlayingthe overlay content based on content of the second frame of the surgicalvideo stream; and generate a composite video stream based on thedetermined first overlay region location and the determined secondoverlay region location.
 2. The computing system of claim 1, wherein thesurgical video stream comprises a video feed of a surgical site from alaparoscope, and the processor is configured to adjust the location andorientation of the overlay content on the surgical site as thelaparoscope moves.
 3. The computing system of claim 1, wherein theoverlay content comprises a secondary surgical video stream associatedwith the surgical procedure, and processor is further configured to:extract a portion of the secondary surgical video stream that comprisesa region of interest; overlay the portion of the secondary surgicalvideo stream onto the first frame of the surgical video stream at thedetermined first overlay region location; and overlay the portion of thesecondary surgical video stream onto the second frame of the surgicalvideo stream at the determined second overlay region location.
 4. Thecomputing system of claim 1, wherein the overlay content comprises atleast one of: a surgical instrument operation status; a surgicalinstrument blade temperature; a surgical instrument loading condition;or steps-for-use instructions associated with a surgical instrument. 5.The computing system of claim 1, wherein the overlay content comprises asupplementary image of an organ associated with the surgical procedure.6. The computing system of claim 1, wherein the processor is furtherconfigured to: identify a predetermined marker in the first frame of thevideo, wherein the first overlay region location in the first frame isdetermined based on a location of the marker in the first frame; andidentify the predetermined marker in the second frame of the video,wherein the second overlay region location in the second frame isdetermined based on a location of the marker in the second frame.
 7. Thecomputing system of claim 6, wherein the predetermined markercorresponds to a fiducial marker on a surgical instrument.
 8. Thecomputing system of claim 1, wherein the processor is further configuredto: determine a first overlay region size for overlaying the overlaycontent onto the first frame based on content of the first frame of thesurgical video stream; determine a second overlay region size foroverlaying the overlay content onto the second frame based on content ofthe second frame of the surgical video stream; and scale the overlaycontent based on the determined first overlay region size and thedetermined second overlay region size.
 9. The computing system of claim8, wherein processor is further configured to: identify a fiducialmarker in the first frame of the surgical video stream; determine a sizeof the fiducial marker in the first frame; calculate the first overlayregion size based on the size of the fiducial marker in the first frame;identify the fiducial marker in the second frame of the surgical videostream; determine a size of the fiducial marker in the second frame; andcalculate the second overlay region size based on the size of thefiducial marker in the second frame.
 10. The computing system of claim1, wherein processor is further configured to: identify a fiducialmarker in the first frame of the video stream; determine an orientationof the fiducial marker in the first frame; determine a first overlayorientation for overlaying the overlay content onto the first framebased on the orientation of the fiducial marker in the first frame;identify the fiducial marker in the second frame of the video stream;determine an orientation of the fiducial marker in the second frame; anddetermine a second overlay orientation for overlaying the overlaycontent onto the second frame based on the orientation of the fiducialmarker m the second frame.
 11. A method comprising: obtaining a surgicalvideo stream associated with a surgical procedure; obtaining overlaycontent associated with the surgical procedure; determining a firstoverlay region location in a first frame of the surgical video streamfor overlaying the overlay content based on content of the first frameof the surgical video stream; determining a second overlay regionlocation in a second frame of the surgical video stream for overlayingthe overlay content based on content of the second frame of the surgicalvideo stream; and generating a composite video stream based on thedetermined first overlay region location and the determined secondoverlay region location.
 12. The method of claim 11, wherein thesurgical video stream comprises a sequence of images of a surgical site,the sequence of images being captured via a laparoscope, and methodfurther comprises: adjusting the location and orientation of the overlaycontent on the surgical site in the sequence of images as thelaparoscope moves.
 13. The method of claim 11, wherein the overlaycontent comprises a secondary surgical video stream associated with thesurgical procedure, and the method further comprises: extracting aportion of the secondary surgical video stream that comprises a regionof interest; overlaying the portion of the secondary surgical videostream onto the first frame of the surgical video stream at thedetermined first overlay region location; and overlaying the portion ofthe secondary surgical video stream onto the second frame of thesurgical video stream at the determined second overlay region location.14. The method of claim 11, wherein the overlay content comprises atleast one of: a surgical instrument operation status; a surgicalinstrument blade temperature; a surgical instrument loading condition;or steps-for-use instructions associated with a surgical instrument. 15.The method of claim 11, wherein the overlay content comprises asupplementary image of an organ associated with the surgical procedure.16. The method of claim 11, further comprising: identifying apredetermined marker in the first frame of the video, wherein the firstoverlay region location in the first frame is determined based on alocation of the marker in the first frame; and identifying thepredetermined marker in the second frame of the video, wherein thesecond overlay region location in the second frame is determined basedon a location of the marker in the second frame.
 17. The method of claim16, wherein the predetermined marker corresponds to a fiducial marker ona surgical instrument.
 18. The method of claim 11, further comprising:determining a first overlay region size for overlaying the overlaycontent onto the first frame based on content of the first frame of thesurgical video stream; determining a second overlay region size foroverlaying the overlay content onto the second frame based on content ofthe second frame of the surgical video stream; and scaling the overlaycontent based on the determined first overlay region size and thedetermined second overlay region size.
 19. The method of claim 18,further comprising: identifying a fiducial marker in the first frame ofthe surgical video stream; determining a size of the fiducial marker inthe first frame; calculating the first overlay region size based on thesize of the fiducial marker in the first frame; identifying the fiducialmarker in the second frame of the surgical video stream; determining asize of the fiducial marker in the second frame; and calculating thesecond overlay region size based on the size of the fiducial marker inthe second frame.
 20. The method of claim 11, further comprising:identifying a fiducial marker in the first frame of the video stream;determining an orientation of the fiducial marker in the first frame;determining a first overlay orientation for overlaying the overlaycontent onto the first frame based on the orientation of the fiducialmarker in the first frame; identifying the fiducial marker in the secondframe of the video stream; determining an orientation of the fiducialmarker in the second frame; and determining a second overlay orientationfor overlaying the overlay content onto the second frame based on theorientation of the fiducial marker in the second frame.